Individual
MR. JERRY LEE GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
550 POPE AVE, MUNSON ARMY HEALTH CENTER (ATTN: MCXN-COD, MS. COTTON), FORT LEAVENWORTH, KS 66027-2332
(913) 684-6562
(913) 684-6208
Mailing address
6522 HEDGE LANE TER, APT 206, SHAWNEE, KS 66226-4872
(360) 584-3952
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
45863
KS
363LF0000X
Family Nurse Practitioner
AP30006651
WA
Other
Enumeration date
07/06/2005
Last updated
07/08/2007
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