Provider Demographics
NPI:1689448409
Name:GREEN, JUDGETTE NATHAINE
Entity type:Individual
Prefix:
First Name:JUDGETTE
Middle Name:NATHAINE
Last Name:GREEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CROMWELL DR STE F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5441
Mailing Address - Country:US
Mailing Address - Phone:252-651-3325
Mailing Address - Fax:
Practice Address - Street 1:710 CROMWELL DR STE F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5441
Practice Address - Country:US
Practice Address - Phone:252-651-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019157363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health