Provider Demographics
NPI:1043754641
Name:GREEN, MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KNOEPFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9228 S MINGO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5721
Mailing Address - Country:US
Mailing Address - Phone:918-592-0999
Mailing Address - Fax:
Practice Address - Street 1:9228 S MINGO RD STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5721
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:918-595-0208
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant