Kanisha Renee Green

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

MPSS-MWBXCL Issued in CA

Practice address

3840 Rosin CT
Sacramento, CA 95834-1639

Phone

(916) 230-2748

NPI assigned

Oct 24, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1609271303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3840 ROSIN CT",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341639",
            "telephone_number": "916-230-2748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 ROSIN CT",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341639",
            "telephone_number": "916-230-2748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3440 Viking Dr Ste 114",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958272844",
            "country_code": "US",
            "telephone_number": "916-287-4067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KANISHA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-MWBXCL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Lee Green
• Jason David Green
• Jeffrey Paul Green, MD
• Kalasia M. Green
• Kalin Green
• Kayla Green
• Lakisha Green
• Marc Thomas Green Sr., CERTIFIED PEER
• Michael Thomas Green, ATC
• Nicholas Green, BCTMB, NCTMB, HHP

• Peer Specialist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.