Individual ProviderKimberly GreenNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address701 Shadow Lane, Las Vegas, NV 89106(702) 383-2000PECOS EnrollmentBased on the most recent information from CMS, provider Kimberly Green is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1902687890Provider TypeIndividualFull NameGreen, KimberlyCredentialMSN, FNP-BCGenderFemaleSole ProprietorNoEnumeration Date10/9/2023Last Updated5/30/2025Contact InformationPractice LocationPractice Address701 Shadow Lane, Las Vegas, NV 89106Phone(702) 383-2000FaxUnlisted FaxMailing LocationMailing Address1800 W Charleston Blvd, Las Vegas, NV 89102-2329Phone(702) 383-2000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense873341NevadaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicenseRN71166Nevada