Healthcare Provider Details

I. General information

NPI: 1972279834
Provider Name (Legal Business Name): KYLE GREEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MEDICAL CENTER PKWY STE 330
MURFREESBORO TN
37129-2586
US

IV. Provider business mailing address

105 MAVELLA CT
GOODLETTSVILLE TN
37072-1338
US

V. Phone/Fax

Practice location:
  • Phone: 615-396-4464
  • Fax:
Mailing address:
  • Phone: 317-502-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242294
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number33188
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: