Provider Demographics
NPI:1336640473
Name:GREEN, PATRICK ALLEN (HEALTH EDUCATOR)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALLEN
Last Name:GREEN
Suffix:
Gender:M
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1706
Mailing Address - Country:US
Mailing Address - Phone:423-573-9873
Mailing Address - Fax:423-573-9875
Practice Address - Street 1:28 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1706
Practice Address - Country:US
Practice Address - Phone:423-573-9873
Practice Address - Fax:423-573-9875
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator