Healthcare Provider Details

I. General information

NPI: 1992482095
Provider Name (Legal Business Name): ASHLEE JADE GREEN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W HOUSTON ST
JASPER TX
75951-4002
US

IV. Provider business mailing address

315 W HOUSTON ST
JASPER TX
75951-4002
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-3430
  • Fax: 409-383-0571
Mailing address:
  • Phone: 409-384-3430
  • Fax: 409-383-0571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1127463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: