1235379173 NPI number — MRS. GINGER R GREENE APRN

Table of content: MRS. GINGER R GREENE APRN (NPI 1235379173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235379173 NPI number — MRS. GINGER R GREENE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
GINGER
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEAVELL
Provider Other First Name:
GINGER
Provider Other Middle Name:
R.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235379173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SOUTH 8TH STREET
Provider Second Line Business Mailing Address:
SUITE 480W
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-753-0704
Provider Business Mailing Address Fax Number:
270-767-3626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S 8TH ST STE 107E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-621-5122
Provider Business Practice Location Address Fax Number:
270-752-2862
Provider Enumeration Date:
03/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3005947 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100231210 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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