MEDICARE: ERICKA 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2023166356	LA
2	363LF0000X	Family Nurse Practitioner	F03211268	LA

General Provider Information

NPI Number	:	1275110900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA GREEN FNP

Provider Business Mailing Address
First Line	:	8923 BLUEBONNET BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8923 BLUEBONNET BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-2814
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

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

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	02/19/2024

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