Provider Demographics
NPI:1982037149
Name:GREENE, CINDRA LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:CINDRA
Middle Name:LYNN
Last Name:GREENE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-1268
Mailing Address - Country:US
Mailing Address - Phone:606-286-4152
Mailing Address - Fax:606-286-2385
Practice Address - Street 1:155 BRICKLAYER STREET
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-1268
Practice Address - Country:US
Practice Address - Phone:606-286-4152
Practice Address - Fax:606-286-2385
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1044926163W00000X
KY3008061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100304410Medicaid
KYK146850Medicare PIN