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General NPI Number Information
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NPI Number | 1982397725
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Entity Type | Individual
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Provider Name | KELSEE BREANN GREEN CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 58 ROY BEALL DR
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City | LUVERNE
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State | AL
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Zip | 36049-6800
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Country | US
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Telephone | 334-335-1212
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Fax | 334-335-1217
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Provider Business Mailing Address
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Address Line | 954 SUNSET BLVD
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City | ELBA
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State | AL
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Zip | 36323-3204
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-153377
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License Number State | AL
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