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NPI Code Detail

MEDICARE: MELISSA GREEN PA-C

MEDICARE: MELISSA GREEN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1013757541
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA GREEN PA-C
Provider Business Mailing Address
First Line : 2621 N WHISENANT DR
Second Line :
City : DUNCAN
State : OK
Zip : 73533-0911
Country : US
Telephone Number : 580-252-5300
Fax Number :
Provider Business Practice Location Address
First Line : 2621 N WHISENANT DR
Second Line :
City : DUNCAN
State : OK
Zip : 73533-0911
Country : US
Telephone Number : 580-252-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2024
Last Update Date : 01/23/2025

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Directions to “ MELISSA GREEN PA-C” Practice Location

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