Provider Demographics
NPI:1083630115
Name:GREEN, TERRY L (NP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S. MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:405-271-7498
Mailing Address - Fax:405-271-4328
Practice Address - Street 1:940 N.E. 13TH STREET
Practice Address - Street 2:SUITE 3000
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5099
Practice Address - Country:US
Practice Address - Phone:405-271-7498
Practice Address - Fax:405-271-4328
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK65023363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200078150AMedicaid
OK200078150AMedicaid
OKOKA100474Medicare PIN