Healthcare Provider Details

I. General information

NPI: 1912371402
Provider Name (Legal Business Name): CATHY JO GREENE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 07/18/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WESTWOOD PL STE 110
BRENTWOOD TN
37027-7554
US

IV. Provider business mailing address

2557 LOWER CLIFT RD
NEWPORT TN
37821-6514
US

V. Phone/Fax

Practice location:
  • Phone: 615-206-2462
  • Fax: 833-983-2043
Mailing address:
  • Phone: 423-470-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20095
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: