Charles Wesley Green III, FNP-BC, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

784730 Issued in CA

Practice address

4445 Colbath Ave Apt 107
Sherman Oaks, CA 91423-3523

Phone

(859) 620-4762

NPI assigned

Jul 22, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• West Coast Wound and Skin Care Inc

  • Surgery Physician
  • Burbank, CA
  • NPI 1437675980
  Medicare reassignment NPD

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1609604859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 COLBATH AVE APT 107",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914233523",
            "telephone_number": "859-620-4762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 COLBATH AVE APT 107",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914233523",
            "telephone_number": "859-620-4762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "CHARLES",
        "middle_name": "WESLEY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "FNP-BC, FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "784730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Grado
• Malcom Graham
• Rosemary Grakal, LMFT
• Natalya Grant
• Hollys Green-Barber
• Sheldon Scott Green, DC
• Dahlia Greenbaum
• Greenberg Chiropractic Inc
• Geraldine Donna Greenberg, DC,LAC
• Jennifer Greene, B.S.

• Family Nurse Practitioner in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.