Provider Demographics
NPI:1992198550
Name:GREEN, SUSANNAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 N CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2403
Mailing Address - Country:US
Mailing Address - Phone:816-741-5542
Mailing Address - Fax:816-746-4262
Practice Address - Street 1:6450 N CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2403
Practice Address - Country:US
Practice Address - Phone:816-741-5542
Practice Address - Fax:816-746-4262
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014040183363LF0000X
IAA139942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily