Provider Demographics
NPI:1154952844
Name:GREEN, MAKAYLA JEAN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:JEAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN, 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:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:FLAT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40935-0735
Mailing Address - Country:US
Mailing Address - Phone:606-302-3525
Mailing Address - Fax:
Practice Address - Street 1:1649 HIGHWAY 192 W
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1674
Practice Address - Country:US
Practice Address - Phone:606-330-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014245363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily