Healthcare Provider Details

I. General information

NPI: 1982144754
Provider Name (Legal Business Name): NANCY JEAN GREEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY JEAN VANSANDT PMHNP-BC

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

10197 LAKE FOREST DR
VANCLEAVE MS
39565-2010
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5000
  • Fax:
Mailing address:
  • Phone: 870-480-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number903936
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number901974
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: