Provider Demographics
NPI:1871784090
Name:GREEN, KRISTIN KYMYANA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:KYMYANA
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 PRYTANIA ST
Mailing Address - Street 2:STE 35
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3628
Mailing Address - Country:US
Mailing Address - Phone:504-897-7197
Mailing Address - Fax:
Practice Address - Street 1:5646 READ BLVD STE 280
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127
Practice Address - Country:US
Practice Address - Phone:504-246-1452
Practice Address - Fax:504-309-4292
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203427207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1005681Medicaid