Individual
GINA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 WATERTOWER BYPASS, CAMPBELLSVILLE, KY 42718-8661
(270) 465-7424
Mailing address
130 SOUTHERN SCHOOL RD, SOMERSET, KY 42501-3223
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/10/2014
Last updated
03/13/2017
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