Green, Mary Alexis K

Green, Mary Alexis K is an individual health care provider with primary practice located at 1455 E Bert Kouns Loop , Shreveport LA 71105-5634. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Green, Mary Alexis K can be contacted via phone (318) 798-4623.

Contact Information

Primary practice address
1455 E Bert Kouns Loop Shreveport LA 71105-5634
Phone: (318) 798-4623
Fax: (318) 798-4646
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.200024 Louisiana

Profile Details

NPI number 1366436487
LBN Legal business name Green, Mary Alexis K
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 2nd, 2005
Last updated Dec 11th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366436487 NPPES
Louisiana MEDICAID 1626244
Louisiana Other P00245408
Louisiana Other 1053315846

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