MEDICARE: MR. KENDRICK ONEAL 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)		LA

General Provider Information

NPI Number	:	1902733660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENDRICK ONEAL GREEN

Provider Business Mailing Address
First Line	:	10815 BIG SUR DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3106
Country	:	US
Telephone Number	:	225-436-6711
Fax Number	:

Provider Business Practice Location Address
First Line	:	10815 BIG SUR DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3106
Country	:	US
Telephone Number	:	225-436-6711
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ MR. KENDRICK ONEAL GREEN ” Practice Location

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