MEDICARE: KRISTIN ANN GREEN FNP-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	363LF0000X	Family Nurse Practitioner	209.023986	IL

General Provider Information

NPI Number	:	1104588227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ANN GREEN FNP-C

Provider Business Mailing Address
First Line	:	4601 E MCCAIN BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2904
Country	:	US
Telephone Number	:	501-945-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 E MCCAIN BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2904
Country	:	US
Telephone Number	:	501-945-4200
Fax Number	:

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

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	05/23/2025

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