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NPI Code Detail

MEDICARE: LAURA ANN GREEN FNP

MEDICARE:   LAURA ANN GREEN  FNP
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
1163W00000XRegistered NurseRN98189TN
2363L00000XNurse PractitionerRN98189TN
3363LF0000XFamily Nurse PractitionerRN199692 NPGA
4363LF0000XFamily Nurse PractitionerAPN6889TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215935499
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ANN GREEN FNP
Provider Business Mailing Address
First Line : 1923 SULPHUR SPRINGS RD
Second Line :
City : MORRISTOWN
State : TN
Zip : 37813-5654
Country : US
Telephone Number : 423-317-9344
Fax Number : 423-714-2355
Provider Business Practice Location Address
First Line : 5600 BRAINERD RD STE A4
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37411-5336
Country : US
Telephone Number : 423-266-4588
Fax Number : 865-342-0103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 09/29/2020

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