Healthcare Provider Details

I. General information

NPI: 1578044376
Provider Name (Legal Business Name): KAMEIKA NEICHELLE GREEN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LEVEE RD
SAINT JOSEPH LA
71366-6661
US

IV. Provider business mailing address

22 AZALEA LN
NATCHEZ MS
39120-8950
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-1967
  • Fax:
Mailing address:
  • Phone: 601-446-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number902553
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: