Provider Demographics
NPI:1528412459
Name:GREENE, EMILY KIRSTEN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KIRSTEN
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 BOY SCOUT RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-6680
Mailing Address - Country:US
Mailing Address - Phone:606-923-7347
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST STE 140
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2876
Practice Address - Country:US
Practice Address - Phone:606-326-1675
Practice Address - Fax:606-326-1436
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2089363AM0700X
KYTC477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165368Medicaid
KYK201160Medicare PIN