Provider Demographics
NPI:1528690732
Name:GREEN, DAWSON (NP, DC)
Entity type:Individual
Prefix:DR
First Name:DAWSON
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:NP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8728
Mailing Address - Country:US
Mailing Address - Phone:425-457-2285
Mailing Address - Fax:
Practice Address - Street 1:841 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3005
Practice Address - Country:US
Practice Address - Phone:316-364-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016282111N00000X
MO2020032639363L00000X
OR10013535363L00000X
KS53-81608-101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor