Active NPI
Carnell Green Jr
- Physician Assistant
- Terre Haute, IN
National Provider Identifier
1972315596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 567 N 5TH St
Terre Haute, IN 47809-1903 - Phone
- (812) 237-3632
- NPI assigned
- Jan 21, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
567 N 5TH St
Terre Haute, IN 47809-1903
Mailing address
805 Granite LN
Conway, AR 72034-3513
Phone (501) 580-6676
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737417600000",
"number": "1972315596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 GRANITE LN",
"city": "CONWAY",
"state": "AR",
"postal_code": "720343513",
"telephone_number": "501-580-6676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "567 N 5TH ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478091903",
"telephone_number": "812-237-3632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN JR",
"first_name": "CARNELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-21",
"last_updated": "2025-01-21",
"certification_date": "2025-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.