Provider Demographics
NPI:1851059281
Name:GREEN, REGINALD SCOTT JR (RN)
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:SCOTT
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 BAINBRIDGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-2019
Mailing Address - Country:US
Mailing Address - Phone:832-439-2253
Mailing Address - Fax:
Practice Address - Street 1:3322 BAINBRIDGE HILL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-2019
Practice Address - Country:US
Practice Address - Phone:832-439-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse