Provider Demographics
NPI:1528340619
Name:GREEN, LORI ANN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP-BC
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Other - Credentials:
Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:758 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2502
Practice Address - Country:US
Practice Address - Phone:615-446-2708
Practice Address - Fax:615-441-5121
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2025-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN000016056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I509261Medicare PIN