Individual
KEVIN LEE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10221 E 81ST ST, TULSA, OK 74133-4559
(918) 252-9300
Mailing address
2408 GALAXY RD, SAPULPA, OK 74066-6800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3016
OK
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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