Provider Demographics
NPI:1568024396
Name:GREEN, HANNA-RAE NIKOHL (NP)
Entity Type:Individual
Prefix:
First Name:HANNA-RAE
Middle Name:NIKOHL
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOSPITAL DR STE 260
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5283
Mailing Address - Country:US
Mailing Address - Phone:423-839-2525
Mailing Address - Fax:
Practice Address - Street 1:120 HOSPITAL DR STE 260
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5283
Practice Address - Country:US
Practice Address - Phone:423-839-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily