Individual
JAMES D GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1216 W MAIN ST, FESTUS, MO 63028-1654
(636) 543-7600
Mailing address
1216 W MAIN ST, FESTUS, MO 63028-1654
(636) 543-7600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2021035759
MO
363LF0000X
Family Nurse Practitioner
2021035759
MO
363LF0000X
Family Nurse Practitioner
53-78679-061
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53-78679-061
KANSAS LICENSE NUMBER
KS
Enumeration date
04/10/2019
Last updated
11/08/2021
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