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General NPI Number Information
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NPI Number | 1609340058
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Entity Type | Individual
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Provider Name | ALICIA MICHELLE GREEN-FARRIS
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Gender | Female
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 802 N BONNIE BRAE ST STE 108
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City | DENTON
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State | TX
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Zip | 76201-2417
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Country | US
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Telephone | 940-514-0133
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Fax | 940-514-0134
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Provider Business Mailing Address
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Address Line | 1124 CANUELA WAY
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City | JUSTIN
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State | TX
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Zip | 76247-1852
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Country | US
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Telephone | 870-489-7220
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1010977
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1010977
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License Number State | TX
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