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General NPI Number Information
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NPI Number | 1487136461
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Entity Type | Individual
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Provider Name | ROBYN KAY GREEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 2819 GREAT NORTHERN LOOP STE 200
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City | MISSOULA
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State | MT
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Zip | 59808
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Country | US
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Telephone | 406-543-1197
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Fax | 406-543-0515
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Provider Business Mailing Address
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Address Line | 2819 GREAT NORTHERN LOOP STE 200
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City | MISSOULA
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State | MT
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Zip | 59808-1750
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Country | US
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Telephone | 406-543-1197
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Fax | 406-543-0515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1155
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 77899
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License Number State | MT
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