Katie L Green (NPI# 1205296795, PAC ID# 4183914914) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1205296795 |
| PAC ID by PECOS | 4183914914 |
| Professional Enrollment ID | I20160607000063 |
| Full Name | Katie L Green |
| Organization Legal Name | LAKESIDE FAMILY MEDICINE |
| Address |
714 Hwy 70 E Kingston OK 73439-8252 |
| Phone Number | 5805640200 |
| Gender | F |
| Graduation Year | 2016 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 6204971112 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 371326 | INTEGRIS MARSHALL COUNTY MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 714 Hwy 70 E, Kingston, OK 73439-8252 | 5805640200 | LAKESIDE FAMILY MEDICINE |
| Organization Legal Name | LAKESIDE FAMILY MEDICINE |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Pamela Ahearn | Family Medicine | Lakeside Family Medicine | 714 Hwy 70 E, Kingston, OK 73439-8252 |
| Meghan Fomby | Nurse Practitioner | Lakeside Family Medicine | 714 Hwy 70 E, Kingston, OK 73439-8252 |
| Amy Lee Goedecke | Nurse Practitioner | Lakeside Family Medicine | 714 Hwy 70 E, Kingston, OK 73439-8252 |
| Street Address |
714 HWY 70 E |
| City | KINGSTON |
| State | OK |
| Zip | 73439-8252 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Pamela Ahearn | Family Medicine | Lakeside Family Medicine | 714 Hwy 70 E, Kingston, OK 73439-8252 |
| Meghan Fomby | Nurse Practitioner | Lakeside Family Medicine | 714 Hwy 70 E, Kingston, OK 73439-8252 |
| Amy Lee Goedecke | Nurse Practitioner | Lakeside Family Medicine | 714 Hwy 70 E, Kingston, OK 73439-8252 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John D Conley | Family Medicine | Marshall County Hma, LLC | 701 E Hwy 70, Pob 762, Kingston, OK 73439-0762 |
| Addie B Gratz | Nurse Practitioner | First Choice Wellness Center LLC | 9 N Main St, Kingston, OK 73439-6562 |
| Leah Cordell | Nurse Practitioner | 7 N Main St, Kingston, OK 73439-6562 | |
| Starla Ranee Harris | Nurse Practitioner | 7 N Main St, Kingston, OK 73439-6562 | |
| Ivora P Sensibaugh | Clinical Social Worker | 208 N Main, Kingston, OK 73439-8016 | |
| Joan W Davis | Clinical Social Worker | 208 N Main, Kingston, OK 73439-8016 | |
| Tressa Matchen | Nurse Practitioner | Marshall County Hmpn, LLC | 701 Hwy 70 E, Kingston, OK 73439-8253 |
| Nedal Amin Elass | Family Medicine | Marshall County Hmpn, LLC | 701 Hwy 70 E, Kingston, OK 73439-8253 |
| City | KINGSTON |
| Zip Code | 73439 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | KINGSTON + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Katie L Green.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.