Katheryn Green, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

630050 Issued in TX

Practice address

533 Pecos St
Chandler, TX 75758-9444

Phone

(903) 849-5173

Fax

(903) 849-2818

NPI assigned

Jun 6, 2006

Last updated

Dec 30, 2008By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Nurse Practitioner

Education

Texas Tech University Health Science Center School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Special Health Resources for Texas, IncorporatedGroup PAC ID 1355326158, shared by 11 NPIs, 14 clinicians

East Texas Infectious Disease Consultants, PLLCGroup PAC ID 7911001375, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katheryn.green@wchcl.eclinicaldirectplus.com
• Direct secure messaging: kgreen25732@christushealth.direct-ci.net
• Direct secure messaging: kgreen355625@ahs.direct-ci.com

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

• East Texas Infectious Disease Consultants, PLLC

  • Infectious Disease Physician
  • Tyler, TX
  • NPI 1912907353
  Medicare reassignment Care Compare group NPD
• Katheryn L Green LLC

  • Family Nurse Practitioner
  • Chandler, TX
  • NPI 1659694909
  Authorized official Same address or phone
• Special Health Resources for Texas, Incorporated

  dba Longview Care Clinic

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1043209919
  NPD (past)
• Special Health Resources for Texas, Incorporated

  dba Midtown Clinic of Tyler

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
  • NPI 1609298132
  NPD (past)
• University of Texas Health Science Center at Tyler-Facility-Physician

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Tyler, TX
  • NPI 1063400778
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mother Frances Hospital Regional Health Care Center

  dba Christus Mother Frances Hospital Tyler

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Care Compare affiliation

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230595200000",
    "number": "1891734489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 PECOS ST",
            "city": "CHANDLER",
            "state": "TX",
            "postal_code": "757589444",
            "telephone_number": "903-849-5173",
            "fax_number": "903-849-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 PECOS ST",
            "city": "CHANDLER",
            "state": "TX",
            "postal_code": "757589444",
            "telephone_number": "903-849-5173",
            "fax_number": "903-849-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KATHERYN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2008-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "630050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "630050",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177762501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Etmc Physician Group Inc.
• First Choice Medical Equipment Solutions LLC
• Lori Folden, FNP
• Lauren Amada Foster, PT, DPT
• William Garre III, M.D.
• Jeremy Ray Gregory, LAT
• Sami Malae Harris, NP
• Janessa Johnson, LPC
• Katheryn L Green LLC
• Richard William Limehouse Jr.

• Family Nurse Practitioner in Chandler, TX
• Providers in Chandler, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.