Healthcare Provider Details

I. General information

NPI: 1003582974
Provider Name (Legal Business Name): NICHOLE MARIE GREEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8656 W GAGE BLVD STE B203
KENNEWICK WA
99336-1154
US

IV. Provider business mailing address

8656 W GAGE BLVD STE B203
KENNEWICK WA
99336-1154
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-0109
  • Fax: 509-420-9851
Mailing address:
  • Phone: 509-579-0109
  • Fax: 509-420-9851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61208028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: