Provider Demographics
NPI:1235379173
Name:GREENE, GINGER R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:R
Other - Last Name:LEAVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:300 SOUTH 8TH STREET
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071
Mailing Address - Country:US
Mailing Address - Phone:270-753-0704
Mailing Address - Fax:270-767-3626
Practice Address - Street 1:300 S 8TH ST STE 107E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2442
Practice Address - Country:US
Practice Address - Phone:707-621-5122
Practice Address - Fax:270-752-2862
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100231210Medicaid
00354003Medicare PIN