Provider Demographics
NPI:1295906634
Name:GREEN, WENDY LYNN (CRNP)
Entity type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:LYNN
Last Name:GREEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W MARKET ST STE B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2456
Mailing Address - Country:US
Mailing Address - Phone:256-233-5000
Mailing Address - Fax:256-233-5361
Practice Address - Street 1:725 W MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2456
Practice Address - Country:US
Practice Address - Phone:256-233-5000
Practice Address - Fax:256-233-5361
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-099815363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-97570OtherBCBS PROVIDER NUMBER
AL631253914OtherTRICARE
AL631253914OtherHUMANA GOLD
631253914OtherHUMANA PROVIDER #
AL631253914OtherCIGNA
AL000097370Medicaid
AL0004582647OtherAETNA
AL63-1253914OtherUNITED HEALTHCARE
AL631253914OtherTRICARE
AL510-97570OtherBCBS PROVIDER NUMBER