Provider Demographics
NPI:1285202028
Name:GREENE, CAITLIN JEAN (NP-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:JEAN
Last Name:GREENE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 NE COLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-8536
Mailing Address - Country:US
Mailing Address - Phone:316-377-9337
Mailing Address - Fax:
Practice Address - Street 1:901 S HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3225
Practice Address - Country:US
Practice Address - Phone:316-322-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80279-062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily