Individual
LISA DIANE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
203 S WATER ST, LOUISA, KY 41230-1347
(606) 649-2211
(606) 638-1399
Mailing address
PO BOX 726, LOUISA, KY 41230-0726
(606) 638-0938
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3011666
KY
363L00000X
Nurse Practitioner
71008164A
IN
363LF0000X
Family Nurse Practitioner
3011666
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3011666
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100542140
—
KY
Enumeration date
09/28/2017
Last updated
12/04/2025
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