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General NPI Number Information
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NPI Number | 1649075359
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Entity Type | Individual
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Provider Name | JENNIFER RENEE GREEN AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 3886 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5219
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Country | US
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Telephone | 910-989-2682
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Fax |
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Provider Business Mailing Address
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Address Line | 105 N WEDGEWOOD DR
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City | WASHINGTON
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State | NC
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Zip | 27889-9231
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Country | US
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Telephone | 817-343-9027
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 5021912
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License Number State | NC
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