MEDICARE: MRS. KIMBERLY GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1336829605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY GREEN

Provider Business Mailing Address
First Line	:	9702 N SAM HOUSTON PKWY E APT 1124
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4547
Country	:	US
Telephone Number	:	832-570-2780
Fax Number	:

Provider Business Practice Location Address
First Line	:	9702 N SAM HOUSTON PKWY E APT 1124
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4547
Country	:	US
Telephone Number	:	832-570-2780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	07/21/2023

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Directions to “ MRS. KIMBERLY GREEN ” Practice Location

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