Active NPI
Carla L Green, APN
- Family Nurse Practitioner
- Johnson City, TN
National Provider Identifier
1588004766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 18086
- Practice address
- 119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998 - Phone
- (423) 282-1480
- Fax
- (423) 928-1353
- NPI assigned
- Jul 2, 2013
- Last updated
- Sep 11, 2015
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 18086 | TN | Primary |
| Family Nurse Practitioner | 363LF0000X | 0024171230 | VA | |
| Critical Care Medicine Registered Nurse | 163WC0200X | RN0000162033 | TN |
Addresses
Primary practice location
119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998
Mailing address
119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998
Phone (423) 282-1480
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN0000162033 | TN | MD | Critical Care Medicine Registered Nurse |
| 0024171230 | VA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441929600000",
"number": "1588004766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 BOONE RIDGE DR",
"address_2": "SUITE 201",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376154998",
"telephone_number": "423-282-1480",
"fax_number": "423-928-1353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 BOONE RIDGE DR",
"address_2": "SUITE 201",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376154998",
"telephone_number": "423-282-1480",
"fax_number": "423-928-1353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "CARLA",
"middle_name": "L",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-02",
"last_updated": "2015-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "18086",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "VA",
"license": "0024171230",
"primary": false
},
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "TN",
"license": "RN0000162033",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.