Active NPI
Kelly Robert Green, M.S.
- Audiologist
- Longview, TX
National Provider Identifier
1942468244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 50324
- Practice address
- 3211 N 4TH St
Ste B
Longview, TX 75605-5145 - Phone
- (903) 758-8346
- Fax
- (903) 757-7876
- NPI assigned
- May 23, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 50324 | TX | Primary |
Addresses
Primary practice location
3211 N 4TH St
Ste B
Longview, TX 75605-5145
Mailing address
400 S Henderson St
Fort Worth, TX 76104-1017
Phone (817) 335-2583
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50324 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211500800000",
"number": "1942468244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 S HENDERSON ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761041017",
"telephone_number": "817-335-2583",
"fax_number": "817-335-2597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3211 N 4TH ST",
"address_2": "STE B",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055145",
"telephone_number": "903-758-8346",
"fax_number": "903-757-7876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KELLY",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-23",
"last_updated": "2008-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "TX",
"license": "50324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.