Individual
ANNIE B GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
66 OLD AIRPORT RD, HATTIESBURG, MS 39401-8382
(601) 544-7500
(601) 544-7524
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-3700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R733618
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123059
—
MS
01
—
11582005
CAQH I D NUMBER
MS
Enumeration date
12/29/2005
Last updated
04/01/2014
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