Kimberly Ruth Green, RNAS-C

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

936159 Issued in TX

Practice address

8591 S Broadway Ave
Tyler, TX 75703-5470

Phone

(903) 606-8840

Fax

(903) 510-1121

NPI assigned

Feb 16, 2023

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

Other names 1

• Kimberly Ruth Walley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1336847623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8591 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035470",
            "telephone_number": "903-606-8840",
            "fax_number": "903-510-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8591 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035470",
            "telephone_number": "903-606-8840",
            "fax_number": "903-510-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KIMBERLY",
        "middle_name": "RUTH",
        "credential": "RNAS-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-16",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "TX",
            "license": "936159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WALLEY",
            "middle_name": "RUTH",
            "credential": "LVN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen A Green, PHARMACIST
• Katie Lynn Green
• Kelli M Green
• Kelsey Green
• Kevin Dwight Green, M.D.
• Lisa Green
• Mandy Green, NP-C
• Marcia W Green, FNP
• Michele Green
• Morgan Green, PA

• Registered Nurse First Assistant in Tyler, TX
• Providers in Tyler, TX by specialty
• Registered Nurse First Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; 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.