Jessica Nichole Greene, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

S1110 Issued in TX

Practice address

405 W Grand Ave
Medical Education Department
Dayton, OH 45405-4720

Phone

(937) 723-3245

Fax

(937) 723-5017

NPI assigned

May 8, 2015

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

• Ms. Jessica Nichole Clark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1346628484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 SGT ED HOLCOMB BLVD S",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773041990",
            "telephone_number": "936-756-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W GRAND AVE",
            "address_2": "MEDICAL EDUCATION DEPARTMENT",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454054720",
            "telephone_number": "937-723-3245",
            "fax_number": "937-723-5017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "233 Sgt Ed Holcomb Blvd S",
            "address_purpose": "LOCATION",
            "city": "Conroe",
            "state": "TX",
            "postal_code": "773041990",
            "country_code": "US",
            "telephone_number": "936-756-8331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5901 Long Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770871003",
            "country_code": "US",
            "telephone_number": "713-970-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "JESSICA",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-08",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "S1110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CLARK",
            "middle_name": "NICHOLE",
            "prefix": "MS.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marc Stuart Greenberg, D.P.M.
• Jeri A Greene-Peyton, LPCC
• Cherylyn G Greene, BSSW, LSW
• Courtney Greene, MSW, LSW
• Erin Andrea Greene, CNS-BC
• Kenneth Wilton Greene, M.D.
• Maria Theresa Greene, RN202371
• Mary K Greene, MD
• Sheldon Greene, PEER SPECIALIST
• Tieranny Greene

• Psychiatry Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Psychiatry Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; 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.