Provider Demographics
NPI:1447459250
Name:GREENE, VICKI S (RN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:S
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MEMORIAL DR.
Mailing Address - Street 2:DEPT. OF VETERANS AFFAIRS
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-743-0139
Mailing Address - Fax:512-433-2073
Practice Address - Street 1:2101 S. IH 35
Practice Address - Street 2:SUITE 121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:512-433-2011
Practice Address - Fax:512-433-2073
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188681401Medicaid
TX8K0989Medicare PIN