Provider Demographics
NPI:1588163885
Name:GREEN, JANUARY LAUREN (FNP-C)
Entity type:Individual
Prefix:DR
First Name:JANUARY
Middle Name:LAUREN
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JANUARY
Other - Middle Name:LAUREN
Other - Last Name:GENTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2007 N COLLINS BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2666
Mailing Address - Country:US
Mailing Address - Phone:214-257-0682
Mailing Address - Fax:
Practice Address - Street 1:5800 RANCHESTER
Practice Address - Street 2:SUITE 125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2470
Practice Address - Country:US
Practice Address - Phone:866-306-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily