Provider Demographics
NPI:1023449402
Name:GREEN, CAROLYN SUE (APRN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SUE
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:MARTIN
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20580
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25362-1580
Mailing Address - Country:US
Mailing Address - Phone:304-344-9834
Mailing Address - Fax:304-344-1756
Practice Address - Street 1:510 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2036
Practice Address - Country:US
Practice Address - Phone:304-344-9834
Practice Address - Fax:304-344-1756
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN76239NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily