Jennifer Renee Green, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

5021912 Issued in NC

Practice address

3886 Henderson Dr
Jacksonville, NC 28546-5219

Phone

(910) 989-2682

NPI assigned

Feb 17, 2025

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1739750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1649075359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N WEDGEWOOD DR",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278899231",
            "telephone_number": "817-343-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3886 HENDERSON DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465219",
            "telephone_number": "910-989-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JENNIFER",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-17",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5021912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Grant
• Jarrod Lawrence Gray, LPC
• Ladina Gray
• Greater Visions Healthcare Services, Inc.
• Ebony L Green
• Joe Anna Green, LCSW
• Maribel Green, LSW
• Lindsay Kailene Greene, COTA/L
• Debra Gregory, RD, LDN
• Gretchen Ann McCord

• Gerontology Nurse Practitioner in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Gerontology Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; 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.