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General NPI Number Information
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NPI Number | 1659694909
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Entity Type | Organization
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Legal Business Name | KATHERYN L GREEN LLC
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 533 PECOS ST
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City | CHANDLER
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State | TX
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Zip | 75758-9444
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Country | US
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Telephone | 903-521-9234
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Fax | 903-849-2818
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Provider Business Mailing Address
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Address Line | PO BOX 929
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City | CHANDLER
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State | TX
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Zip | 75758-0929
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Country | US
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Telephone | 903-521-9234
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Fax | 903-849-2818
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | MRS. KATHERYN LEA GREEN
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Credential | RN, FNP-C
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Telephone | 903-521-9234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 630050
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License Number State | TX
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