Provider Demographics
NPI:1740700251
Name:GREEN, KARLY CHRISTINE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KARLY
Middle Name:CHRISTINE
Last Name:GREEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:KARLY
Other - Middle Name:CHRISTINE
Other - Last Name:FATICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2469 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-9446
Mailing Address - Country:US
Mailing Address - Phone:814-490-5563
Mailing Address - Fax:
Practice Address - Street 1:527 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1227
Practice Address - Country:US
Practice Address - Phone:330-797-0070
Practice Address - Fax:330-797-9146
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.449510163W00000X
OHAPRN.CNP.022907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse