Provider Demographics
NPI:1073762092
Name:GREEN, AARON W (RN)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:W
Last Name:GREEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 US HIGHWAY 371
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-7064
Mailing Address - Country:US
Mailing Address - Phone:870-887-3660
Mailing Address - Fax:870-887-3705
Practice Address - Street 1:2904 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2536
Practice Address - Country:US
Practice Address - Phone:870-773-4655
Practice Address - Fax:870-772-4650
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR71326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse