Individual
PAMELA DIANE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
225 MEDICAL CENTER DR STE 201, PADUCAH, KY 42003-7907
(270) 444-4250
(270) 444-4260
Mailing address
2200 JEFFERSON AVE, 5TH FLOOR MERCY PHO/CVO, TOLEDO, OH 43604-7101
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
3004702
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78015773
—
KY
01
—
CN0807
R.R.M.C.
—
01
—
K232280
MEDICARE PTAN
KY
Enumeration date
11/15/2006
Last updated
05/01/2018
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