Active NPI
Kelly Green, PA-C
- Physician Assistant
- Wake Forest, NC
National Provider Identifier
1255887386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001006672
- Practice address
- 1237 Shirehall Park LN
Wake Forest, NC 27587-0601 - Phone
- (919) 667-3714
- NPI assigned
- Aug 29, 2016
- Last updated
- Aug 29, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001006672 | NC | Primary |
Addresses
Primary practice location
1237 Shirehall Park LN
Wake Forest, NC 27587-0601
Mailing address
1237 Shirehall Park LN
Wake Forest, NC 27587-0601
Phone (919) 667-3714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001006672 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472428800000",
"number": "1255887386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1237 SHIREHALL PARK LN",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275870601",
"telephone_number": "919-667-3714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1237 SHIREHALL PARK LN",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275870601",
"telephone_number": "919-667-3714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KELLY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-29",
"last_updated": "2016-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "001006672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.