Healthcare Provider Details

I. General information

NPI: 1619898855
Provider Name (Legal Business Name): KE'ASIA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GLENMAR AVE
MONROE LA
71201-5309
US

IV. Provider business mailing address

3980 OLD STERLINGTON RD APT 508
MONROE LA
71203-2687
US

V. Phone/Fax

Practice location:
  • Phone: 318-327-8223
  • Fax:
Mailing address:
  • Phone: 318-880-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: