Provider Demographics
NPI:1487136461
Name:GREEN, ROBYN KAY (PA-C)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:KAY
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 GREAT NORTHERN LOOP STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1750
Mailing Address - Country:US
Mailing Address - Phone:406-543-1197
Mailing Address - Fax:406-543-0515
Practice Address - Street 1:2819 GREAT NORTHERN LOOP STE 200
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808
Practice Address - Country:US
Practice Address - Phone:406-543-1197
Practice Address - Fax:406-543-0515
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1155363A00000X
MT77899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant