Katheryn Green, NP
Individual provider Active NPI Family Nurse Practitioner · Chandler, TX
NPI 1891734489 · NPPES record last updated Dec 30, 2008
Key facts
- NPI
- 1891734489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 630050 (TX)
- Practice address
- 533 Pecos St
Chandler, TX 75758-9444 - Phone
- (903) 849-5173
- Fax
- (903) 849-2818
- NPI assigned
- Jun 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 13
Hospital & facility affiliations 1
Medicare Care Compare profile
- 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, Incorporated
East Texas Infectious Disease Consultants, PLLC
Practice addresses (Care Compare)
1300 Clinic Dr
Tyler, TX 75701-2119
Phone (903) 597-7558
935 S Baxter Ave
Suite 103
Tyler, TX 75701-2245
Phone (903) 592-4473
Hospital & facility affiliations
- Christus Mother Frances Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051220000442 | TX | Practitioner - Nurse Practitioner | 8325060221 |
Reassigns benefits to 1 organization Practice locations: Chandler, TX; Frankston, TX; Gladewater, TX; Henderson, TX; Mineola, TX; Tyler, TX; Whitehouse, TX |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Texas Infectious Disease Consultants, PLLC | Current |
Accepting new patients | |
| Special Health Resources for Texas, Incorporated | Past | Accepting new patients | |
| University of Texas Health Science Center at Tyler-Facility-Physician | Past |
Accepting new patients | |
| Special Health Resources for Texas, Incorporated | Past | Accepting new patients |
Locations
935 S Baxter Ave
Ste 103
Tyler, TX 75701
Phone (903) 592-4473
Interoperability endpoints
- kgreen25732@christushealth.direct-ci.net
- katheryn.green@wchcl.eclinicaldirectplus.com
- kgreen355625@ahs.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 630050 | TX | Yes |
Addresses
Primary practice location
533 Pecos St
Chandler, TX 75758-9444
Mailing address
533 Pecos St
Chandler, TX 75758-9444
Phone (903) 849-5173
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 177762501 | Medicaid | TX | |
| 630050 | Other | TX | NURSE PRACTITIONER |
Other providers in Chandler, TX
- Etmc Physician Group Inc.
- First Choice Medical Equipment Solutions LLC
- Lori Folden
- Lauren Amada Foster
- William Garre III
- Jeremy Ray Gregory
- Sami Malae Harris
- Janessa Johnson
- Katheryn L Green LLC
- Richard William Limehouse Jr.
All providers in Chandler, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.