Healthcare Provider Details

I. General information

NPI: 1962811554
Provider Name (Legal Business Name): REBECCA FERRELL GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 ALEXANDER RD STE A
DUBLIN VA
24084-3657
US

IV. Provider business mailing address

PO BOX 297
WHITE SULPHUR SPRINGS WV
24986-0297
US

V. Phone/Fax

Practice location:
  • Phone: 540-307-5597
  • Fax:
Mailing address:
  • Phone: 304-536-5030
  • Fax: 866-903-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number56912
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: