Individual
MRS. MERRY LYNN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
904 WALLACE AVE, LEITCHFIELD, KY 42754-1418
(270) 259-9470
(270) 259-1662
Mailing address
PO BOX 265, CANEYVILLE, KY 42721-0265
(270) 879-8924
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1023194
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106570
PASSPORT
KY
01
—
2746310000
PASSPORT ADVANTAGE
KY
05
—
74191438
—
KY
Enumeration date
11/03/2006
Last updated
10/22/2007
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