Provider Demographics
NPI:1376905844
Name:GREEN, CATHY (NP-C)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:GREEN
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 1:3165 FM 2540 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414
Mailing Address - Country:US
Mailing Address - Phone:979-429-0221
Mailing Address - Fax:
Practice Address - Street 1:600 HOSPITAL CIRCLE
Practice Address - Street 2:SUITE 201
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414
Practice Address - Country:US
Practice Address - Phone:979-245-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily