Individual
MRS. STACY RENEE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1100 N 4TH ST, LEAVENWORTH, KS 66048-1572
(913) 297-9945
Mailing address
9712 E 69TH ST, RAYTOWN, MO 64133-5945
(816) 213-4601
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2021029668
MO
363LF0000X
Family Nurse Practitioner
5380729022
KS
Other
Enumeration date
12/10/2021
Last updated
05/16/2025
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