Provider Demographics
NPI:1538561113
Name:GREEN, SARRAH (NP)
Entity type:Individual
Prefix:MRS
First Name:SARRAH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SARRAH
Other - Middle Name:
Other - Last Name:GOUDREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:291 LEATHERWOOD BAY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-4507
Mailing Address - Country:US
Mailing Address - Phone:931-338-8900
Mailing Address - Fax:
Practice Address - Street 1:12088 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:KY
Practice Address - Zip Code:42262-9370
Practice Address - Country:US
Practice Address - Phone:931-338-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19136363L00000X
KY3011011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100470780Medicaid
KY7100470780Medicaid