Individual provider Active NPI

Abigail Mackenzie Green

  • Student in an Organized Health Care Education/Training Program
  • Jefferson, LA
National Provider Identifier
1396548160
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1401 Jefferson Hwy FL Center1
Jefferson, LA 70121-2426
Phone
(504) 842-3260
Fax
(504) 842-3193
NPI assigned
Mar 28, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1401 Jefferson Hwy FL Center1
Jefferson, LA 70121-2426

Mailing address

802 McCormick St
Shreveport, LA 71104-4818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250627002608 LA Order and Referring Only - Obstetrics/GynecologyPractitioner - Obstetrics/Gynecology 8628581295

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1396548160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 MCCORMICK ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711044818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 JEFFERSON HWY FL CENTER1",
            "city": "JEFFERSON",
            "state": "LA",
            "postal_code": "701212426",
            "telephone_number": "504-842-3260",
            "fax_number": "504-842-3193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ABIGAIL",
        "middle_name": "MACKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-28",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, LA

Sources for this page

Verify at the official NPI Registry.