Active NPI
Teresa Diane Green
- Homemaker
- Sikeston, MO
National Provider Identifier
1104154293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- License
- 19920393
- Practice address
- 415 W Gladys St
Sikeston, MO 63801-2733 - Phone
- (573) 475-9254
- Fax
- (573) 475-9254
- NPI assigned
- Nov 30, 2009
- Last updated
- Nov 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | 19920393 | MO | Primary |
Addresses
Primary practice location
415 W Gladys St
Sikeston, MO 63801-2733
Mailing address
415 W Gladys St
Sikeston, MO 63801-2733
Phone (573) 475-9254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19920393 | MO | MD | Homemaker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259539200000",
"number": "1104154293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 W GLADYS ST",
"city": "SIKESTON",
"state": "MO",
"postal_code": "638012733",
"telephone_number": "573-475-9254",
"fax_number": "573-475-9254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 W GLADYS ST",
"city": "SIKESTON",
"state": "MO",
"postal_code": "638012733",
"telephone_number": "573-475-9254",
"fax_number": "573-475-9254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "TERESA",
"middle_name": "DIANE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-30",
"last_updated": "2009-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "MO",
"license": "19920393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sikeston, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.