Active NPI
Pamela Kellam Green
- Home Health Agency
- Jacksonville, FL
National Provider Identifier
1730716648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 688784896
- Practice address
- 6986 Jack Horner LN
Jacksonville, FL 32210-3620 - Phone
- (904) 710-9662
- Fax
- (904) 586-2473
- NPI assigned
- Mar 23, 2020
- 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 |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 688784896 | FL | Primary |
Addresses
Primary practice location
6986 Jack Horner LN
Jacksonville, FL 32210-3620
Mailing address
4575 St. Johns Avenue
Suite # 4
Jacksonville, FL 32210
Phone (904) 710-9662
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 |
|---|---|---|---|
| 688784896 | FL | MD | Home Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584921600000",
"number": "1730716648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4575 ST. JOHNS AVENUE",
"address_2": "SUITE # 4",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32210",
"telephone_number": "904-710-9662",
"fax_number": "904-586-2473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6986 JACK HORNER LN",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322103620",
"telephone_number": "904-710-9662",
"fax_number": "904-586-2473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "PAMELA",
"middle_name": "KELLAM",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-23",
"last_updated": "2020-03-23",
"certification_date": "2020-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "FL",
"license": "688784896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.