Provider Demographics
NPI:1831533223
Name:GREEN, CATES GENTRY (PA-C)
Entity type:Individual
Prefix:MS
First Name:CATES
Middle Name:GENTRY
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:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:9430 PARK WEST BLVD STE 130
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4205
Practice Address - Country:US
Practice Address - Phone:865-690-4486
Practice Address - Fax:865-560-8525
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2545363A00000X, 363AS0400X
SC1915363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01477134OtherRR MEDICARE
TNQ005835Medicaid
TN4935437OtherAETNA
TN6017704OtherBLUECROSS BLUESHIELD - PA SURGICAL
TN6017703OtherBLUECROSS BLUESHIELD
TN6017703OtherBLUECROSS BLUESHIELD
TNP01477134OtherRR MEDICARE