Provider Demographics
NPI:1609610591
Name:GREEN, CHRISTINA NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 BIRSEMORE LOCH DR
Mailing Address - Street 2:
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4745
Mailing Address - Country:US
Mailing Address - Phone:209-242-6710
Mailing Address - Fax:
Practice Address - Street 1:12702 BIRSEMORE LOCH DR
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-4745
Practice Address - Country:US
Practice Address - Phone:209-242-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167637363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health