Corey Nicole Green, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2455 Issued in OK

Practice address

29501 Kickapoo Rd
McLoud, OK 74851-8320

Phone

(405) 964-3020

NPI assigned

Mar 2, 2015

Last updated

Mar 2, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1255723110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30208 WACO RD",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "748519012",
            "telephone_number": "405-245-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29501 KICKAPOO RD",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "748518320",
            "telephone_number": "405-964-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "COREY",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-02",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Garcia-Varney, COTA,L
• Claudia Garcia, B.S
• Amanda Garner
• Val Gene Gokey, M.ED.
• Mark I Gomez
• Destini Green, DCS
• Jennifer Lee Griffith, MHP
• Alexandrea Grigg, M.S. CCC-SLP
• Allison R Halford, PHARM.D.
• Kimberly K Hanigar, M.D.

• Physician Assistant in McLoud, OK
• Providers in McLoud, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.