Healthcare Provider Details

I. General information

NPI: 1598538571
Provider Name (Legal Business Name): GREEN MEDICAL AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MCINGVALE RD
HERNANDO MS
38632-8755
US

IV. Provider business mailing address

2350 MCINGVALE RD
HERNANDO MS
38632-8755
US

V. Phone/Fax

Practice location:
  • Phone: 662-912-6399
  • Fax:
Mailing address:
  • Phone: 662-912-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE PEGGINS
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 901-601-0266