Provider Demographics
NPI:1972937316
Name:GREEN, TRICIA G (APN)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:G
Last Name:GREEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:ANGLEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:2001 SOUTH MEDFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4463
Mailing Address - Country:US
Mailing Address - Phone:936-639-1141
Mailing Address - Fax:
Practice Address - Street 1:907 KINCAID PL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:512-450-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808780364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health