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General NPI Number Information
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NPI Number | 1598538571
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Entity Type | Organization
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Legal Business Name | GREEN MEDICAL AND CONSULTING, LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 2350 MCINGVALE RD
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City | HERNANDO
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State | MS
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Zip | 38632-8755
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Country | US
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Telephone | 662-912-6399
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 MCINGVALE RD
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City | HERNANDO
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State | MS
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Zip | 38632-8755
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Country | US
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Telephone | 662-912-6399
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | KRISTIE PEGGINS
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Credential | NP
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Telephone | 901-601-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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