MEDICARE: GEORGETTE GREENE 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3010880	KY
2	363LF0000X	Family Nurse Practitioner	3010880	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
2	3010880	OTHER	KY	LICENSE

General Provider Information

NPI Number	:	1700322385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGETTE GREENE APRN

Provider Business Mailing Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2174
Country	:	US
Telephone Number	:	606-783-6400
Fax Number	:	606-783-6415

Provider Business Practice Location Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2174
Country	:	US
Telephone Number	:	606-775-0515
Fax Number	:	606-552-0694

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

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	12/04/2025

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Directions to “ GEORGETTE GREENE APRN” Practice Location

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