Provider Demographics
NPI:1043660194
Name:GREEN, ERIN L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E MATTHEWS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3120
Mailing Address - Country:US
Mailing Address - Phone:870-207-7555
Mailing Address - Fax:870-207-0520
Practice Address - Street 1:303 E MATTHEWS AVE STE 202
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3120
Practice Address - Country:US
Practice Address - Phone:870-207-7555
Practice Address - Fax:870-207-0520
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR218056758Medicaid
AR218056758Medicaid
AR519511ZQQ9Medicare PIN