MEDICARE: REBEKAH 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
1	363A00000X	Physician Assistant	APA2513	OK

General Provider Information

NPI Number	:	1073908836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH GREEN PA-C

Provider Business Mailing Address
First Line	:	1810 E MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1250
Country	:	US
Telephone Number	:	405-607-4333
Fax Number	:	405-607-4404

Provider Business Practice Location Address
First Line	:	1810 E MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-1250
Country	:	US
Telephone Number	:	405-607-4333
Fax Number	:	405-607-4404

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	06/23/2016

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Directions to “ REBEKAH GREEN PA-C” Practice Location

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