Provider Demographics
NPI:1760814602
Name:GREEN, ANNETTE LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LYNN
Last Name:GREEN
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-367-3360
Mailing Address - Fax:502-367-3365
Practice Address - Street 1:727 HOSPITAL DR
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1660
Practice Address - Country:US
Practice Address - Phone:502-647-4000
Practice Address - Fax:502-647-4338
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-11-25
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Provider Licenses
StateLicense IDTaxonomies
KY3007896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100259920Medicaid
KYK086980 (JPG)Medicare PIN