ZANDRAL KEWAN GREEN (NPI# 1124643069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124643069 |
| Entity Type | Individual |
| Full Name | ZANDRAL KEWAN GREEN |
| Practice Address |
3442 Wisconsin Ave Vicksburg MS 39180-5331 |
| Mailing Address |
4222 Commons Cir Vicksburg MS 39180-5858 |
| Practice Telephone | 6016340181 |
| Mailing Telephone | 6017029411 |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00018215 | 05 |
| Street Address |
3442 WISCONSIN AVE |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629578729 | Kidzplay Community | Counselor | 1010 Monroe St, Vicksburg, MS 39183-2552 | 2018-02-15 |
| 1093214751 | Linda Sweezer Enterprises, LLC | Counselor | 1301 Holly St, Vicksburg, MS 39180-3665 | 2018-02-08 |
| 1760981773 | M & M Behavioral Health Center | Counselor | 1911 Mission 66 Ste G, Vicksburg, MS 39180-3762 | 2018-02-05 |
| 1932408382 | Tenecia Bullock | Counselor | 3334 Wisconsin Avenue, Warren-yazoo Mental Health Services, Vicksburg, MS 39180-2067 | 2011-03-24 |
| 1538475173 | Jonathan Reeves | Counselor | 4333 Wisconsin Ave., Vicksburg, MS 39180-2067 | 2010-08-20 |
| 1255657755 | Pamela Brookins | Counselor | 3444 Wisconsin Ave., Vicksburg, MS 39180-2067 | 2010-04-09 |
| 1598913881 | Lisa Hackett | Counselor | 3444 Wiscosin Ave., Vicksburg, MS 39180-2067 | 2008-08-29 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1740474915 | Joseph Daniel Johnson | Counselor | 1911 Mission 66 Ste B, Suite B, Vicksburg, MS 39180-3762 | 2007-08-30 |
| 1518925866 | James P. Flanders | Counselor | 800 Belmont St, Vicksburg, MS 39180-3828 | 2006-05-03 |
| Find all providers in VICKSBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.