MEDICARE: TABITHA T GREEN APRN

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	3007564	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1578817110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA T GREEN APRN

Provider Business Mailing Address
First Line	:	2816 VEACH RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-6295
Country	:	US
Telephone Number	:	270-926-9821
Fax Number	:	270-667-4260

Provider Business Practice Location Address
First Line	:	2816 VEACH RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-6295
Country	:	US
Telephone Number	:	270-926-9821
Fax Number	:	270-667-4260

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	02/05/2026

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