Kelly Kathleen Greene, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

6301011602 Issued in MI

Practice address

701 US Highway 31 S
Traverse City, MI 49685-8016

Phone

(989) 497-2500

NPI assigned

May 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mary Free Bed Rehabilitation Hospital

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
  • NPI 1053641589
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1508810318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 US HIGHWAY 31 S",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496858016",
            "telephone_number": "989-497-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 US HIGHWAY 31 S",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496858016",
            "telephone_number": "989-497-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "KELLY",
        "middle_name": "KATHLEEN",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301011602",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301011602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508810318",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenifer Lyn Green, CNP
• Katherine Green
• Nicole Lynn Green
• Taryn Green, PTA
• Timothy Green
• Jill R Greenfield, PT
• Courtney Marie Greening, P.T.
• Greenlund Enterprises, Inc
• Steven Greenman, LPC
• Austin David Greiner

• Clinical Neuropsychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Neuropsychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.