Jerry Lee Green Jr., FNP
Individual provider Active NPI Family Nurse Practitioner · Fort Leavenworth, KS
NPI 1366449316 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366449316
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 45863 (KS)
- Practice address
- 550 Pope Ave
Munson Army Health Center (Attn: MCXN-Cod, Ms. Cotton)
Fort Leavenworth, KS 66027-2332 - Phone
- (913) 684-6562
- Fax
- (913) 684-6208
- NPI assigned
- Jul 6, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45863 | KS | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP30006651 | WA | |
| Family Nurse Practitioner | 363LF0000X | 45863 | KS | Yes |
Addresses
Primary practice location
550 Pope Ave
Munson Army Health Center (Attn: MCXN-Cod, Ms. Cotton)
Fort Leavenworth, KS 66027-2332
Mailing address
6522 Hedge Lane Ter
Apt 206
Shawnee, KS 66226-4872
Phone (360) 584-3952
Other providers in Fort Leavenworth, KS
- Alexis Garcia
- Julie Michelle Gary
- William Glazier
- Richelle Ly Goodin
- Joshua Alan Graf
- Maria Grisel Gregory
- Kristie Michelle Grenier
- Veronica A. Griffith
- Shari Angelique Guinn
- Kristie L Hager
All providers in Fort Leavenworth, KS · Family Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.