MEDICARE: CRISTINA KAYE GREEN ED.S.

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
1	103TS0200X	School Psychologist	200402966	KY

General Provider Information

NPI Number	:	1063269504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA KAYE GREEN ED.S.

Provider Business Mailing Address
First Line	:	3321 BLACKFORD PKWY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-9070
Country	:	US
Telephone Number	:	859-629-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 BLACKFORD PKWY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-9070
Country	:	US
Telephone Number	:	859-629-1203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2024
Last Update Date	:	05/02/2024

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Directions to “ CRISTINA KAYE GREEN ED.S.” Practice Location

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