Provider Demographics
NPI:1184226078
Name:GREEN, KELLY HEALANI (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:HEALANI
Last Name:GREEN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MRS
Other - First Name:KELLY-ANNE
Other - Middle Name:HEALANI
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:95-207 HOAHELE PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5544
Mailing Address - Country:US
Mailing Address - Phone:808-626-8012
Mailing Address - Fax:
Practice Address - Street 1:94-216 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:619-672-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI40000163W00000X
HIAPRN-3085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse