Healthcare Provider Details

I. General information

NPI: 1528340619
Provider Name (Legal Business Name): LORI ANN GREEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 HIGHWAY 46 S
DICKSON TN
37055-2502
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR SUITE 209
DICKSON TN
37055-2855
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-2708
  • Fax: 615-441-5121
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000016056
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: