Individual
REBECCA L GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2500 CANTERBURY DR, SUITE 112, HAYS, KS 67601-2247
(785) 261-7599
Mailing address
2500 CANTERBURY DR, SUITE 112, HAYS, KS 67601-2247
(785) 261-7599
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
15-01210
KS
363AS0400X
Surgical Physician Assistant
2007028966
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39905011
BCBS TRICARE
—
01
—
P00467259
RR MEDICARE-MO
MO
01
—
P00467266
RR MEDICARE-KS
KS
Enumeration date
08/10/2007
Last updated
11/28/2011
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