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NPI Code Detail

MEDICARE: MR. ROBERT ALLEN GREEN PMHNP-BC

MEDICARE: MR. ROBERT ALLEN GREEN PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner221575LA

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 : 1487328464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT ALLEN GREEN PMHNP-BC
Provider Business Mailing Address
First Line : 300 HIGHLAND VIEW DR
Second Line :
City : YOUNGSVILLE
State : LA
Zip : 70592-6080
Country : US
Telephone Number : 318-834-6298
Fax Number :
Provider Business Practice Location Address
First Line : 113 FLAGG PL BLDG B
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-7025
Country : US
Telephone Number : 337-247-7282
Fax Number : 337-279-0776
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2021
Last Update Date : 01/05/2023

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