Healthcare Provider Details

I. General information

NPI: 1518434588
Provider Name (Legal Business Name): ALLISON MICHELLE GREEN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W VETERANS BLVD
BIG SPRING TX
79720-5566
US

IV. Provider business mailing address

118 BAGPIPE RD
SAN ANGELO TX
76901-9500
US

V. Phone/Fax

Practice location:
  • Phone: 432-264-4869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: