MEDICARE: CASEY NICHOLE 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	5601007872	MI

General Provider Information

NPI Number	:	1457703548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY NICHOLE GREEN PA-C

Provider Business Mailing Address
First Line	:	1023 BUSINESS PARK DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-8372
Country	:	US
Telephone Number	:	231-389-6982
Fax Number	:	231-216-7648

Provider Business Practice Location Address
First Line	:	1023 BUSINESS PARK DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-8372
Country	:	US
Telephone Number	:	231-389-6982
Fax Number	:	231-216-7648

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	06/18/2026

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