Kenneth Leroy Green Jr.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Practice address

7939 W Gulf to Lake Hwy
Crystal River, FL 34429-7931

Phone

(352) 257-7874

NPI assigned

Nov 15, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: kennygreen@mymobilitymedical.com

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1699310466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 HAMLIN AVE",
            "city": "HOWEY IN THE HILLS",
            "state": "FL",
            "postal_code": "347373706",
            "telephone_number": "352-516-1347",
            "fax_number": "813-354-2497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7939 W GULF TO LAKE HWY",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344297931",
            "telephone_number": "352-257-7874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KENNETH",
        "middle_name": "LEROY",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-15",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kennygreen@mymobilitymedical.com",
            "affiliation": "N",
            "address_1": "7939 W Gulf To Lake Hwy",
            "city": "Crystal River",
            "state": "FL",
            "country_code": "US",
            "postal_code": "344297931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jean Gonsette, PHYSICAL THERAPIST
• Jennifer Joy Gonsman, LMT
• Kady Rae Gonzalez, PHARM D
• Paulette Gorlin, APRN
• John Willard Grace III, M.D.
• Shikerria Green, MD
• Denis Walter Grillo, D.O.
• William Steve Gruss, M.D.
• Gulf Coast Physical Therapy, Inc
• H and J Done Right LLC

• Durable Medical Equipment & Medical Supplies in Crystal River, FL
• Providers in Crystal River, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; 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.