Provider Demographics
NPI:1518510833
Name:GREEN, AMY NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:NEASBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1817 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-7364
Mailing Address - Country:US
Mailing Address - Phone:903-818-2321
Mailing Address - Fax:
Practice Address - Street 1:300 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7388
Practice Address - Country:US
Practice Address - Phone:903-868-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142245363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology