Individual
MANDY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
910 E HOUSTON ST, STE 230, TYLER, TX 75702-8369
(903) 525-7300
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
679662
TX
363L00000X
Nurse Practitioner
Primary
AP122656
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
679662
TEXAS BOARD OF NURSING
TX
Enumeration date
11/06/2012
Last updated
04/17/2025
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