Provider Demographics
NPI:1609007418
Name:GREEN, CHARITY ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CHARITY
Other - Middle Name:ANN
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4303 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7507
Mailing Address - Country:US
Mailing Address - Phone:512-462-3627
Mailing Address - Fax:512-462-3431
Practice Address - Street 1:4303 VICTORY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7507
Practice Address - Country:US
Practice Address - Phone:512-462-3627
Practice Address - Fax:512-462-3431
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP810244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily