Individual
MRS. KATHY GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC
Contact information
Practice address
5424 DISCOVERY PARK BOULEVARD, BLDG. B SUITE 204, WILLIAMSBURG, VA 23188
(757) 707-3508
Mailing address
860 OMNI BLVD STE 303, NEWPORT NEWS, VA 23606-4477
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024174126
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024174126
STATE MEDICAL LICENSE
VA
Enumeration date
11/02/2016
Last updated
09/28/2018
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