| Doctor Name: | MR. JERRY LEE GREEN |
| NPI Number: | 1366449316 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | AP30006651 |
| Business Practice Address: | 550 Pope Ave Munson Army Health Center (attn: Mcxn-cod, Ms. Cotton) Fort Leavenworth, KS - 660272332 |
| Business Phone Number: | 9136846562 |
| Business Fax Number: | 9136846208 |
| Mailing Address: | 6522 Hedge Lane Ter, Apt 206 SHAWNEE |
| State: | KS |
| Postal Code: | 662264872 |
| Phone Number: | 3605843952 |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP30006651 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |