Provider Demographics
NPI:1699916130
Name:GREEN, KATIE ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:STE 600
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-561-3003
Mailing Address - Fax:816-889-1584
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:STE 600
Practice Address - City:N KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-561-3003
Practice Address - Fax:816-889-1584
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2018-04-03
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Provider Licenses
StateLicense IDTaxonomies
MO2009005434363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical