Healthcare Provider Details

I. General information

NPI: 1538141221
Provider Name (Legal Business Name): LYNDA ANN GREEN CNP GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S DUNCAN ST
JAMESTOWN TN
38556-3009
US

IV. Provider business mailing address

PO BOX 2861
CROSSVILLE TN
38557-2861
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-5864
  • Fax:
Mailing address:
  • Phone: 931-879-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP145992
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number53135-1214
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP02366
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA002938
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO1214
License Number StateLA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35835
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPO1214
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPO1214
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: