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Individual

ANDREA C GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
711 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3439
(859) 287-3045
(859) 578-3800
Mailing address
PO BOX 636324, CINCINNATI, OH 45263-6324
(859) 287-3045
(859) 578-3800

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10004353A
IN
363A00000X
Physician Assistant
55001096
OH
363A00000X
Physician Assistant
Primary
PA900
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0077725
OH
05
95006151
KY
Enumeration date
12/30/2005
Last updated
12/18/2025
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