KATEY ELIZABETH GREEN (APRN) – Nurse Practitioner, NPI 1104519586

KATEY ELIZABETH GREEN (APRN) is a healthcare provider. based in Wallingford, Connecticut. specializing in NURSE PRACTITIONER. They hold the professional credentials APRN. They hold a License No. 11276 (CT). The NPI Number for KATEY ELIZABETH GREEN (APRN) is 1104519586

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
KATEY ELIZABETH GREEN (APRN)
NPI
1104519586
Phone
(203) 284-2800
Address
50 GAYLORD FARM RD
Enumeration Date
31 May 2023
Last Update Date
31 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2032842800
Graduation Year
2022 (4 years ago)
PAC ID
0143683557
Group Practice PAC ID
1153224191
Professional Enrollment ID
I20230901001675
Address ID
CT064922828WA50XXXRDXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

4,191 NURSE PRACTITIONER in CT

Provider Addresses for KATEY ELIZABETH GREEN (APRN)

  • 50 GAYLORD FARM RD

    WALLINGFORD, CT 064922828

    Phone: (203) 284-2800

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-09-01

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230901001675INurse PractitionerCTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06492)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1153224191View full group profile
NameSpecialtyState
Nuclear Medicine, Cardiovascular Disease (Cardiology), Internal MedicineCT
Physical Medicine And RehabilitationCT
-CT
Physical Medicine And RehabilitationNY
Clinical PsychologistMA
Internal MedicineCT
Gastroenterology, Internal MedicineCT
Internal Medicine, HospitalistCT
Interventional Pain ManagementCT
Physical Medicine And RehabilitationCT

Reviews

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Frequently asked questions

What is the registry number for KATEY ELIZABETH GREEN (APRN)?
The registry entry for KATEY ELIZABETH GREEN (APRN) shows NPI 1104519586.
Quick check: is KATEY ELIZABETH GREEN (APRN) active?
Public NPPES data shows KATEY ELIZABETH GREEN (APRN) with an active NPI status right now.
What does the directory say KATEY ELIZABETH GREEN (APRN) does?
Insurance directories may phrase it differently, but here KATEY ELIZABETH GREEN (APRN) maps to Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What city is tied to KATEY ELIZABETH GREEN (APRN)?
The directory associates KATEY ELIZABETH GREEN (APRN) with Wallingford, Connecticut. Check all listed addresses for suites or satellite offices.
Who maintains KATEY ELIZABETH GREEN (APRN)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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