Active NPI
Juanita Rosalyn Green, PPS
- Case Manager/Care Coordinator
- Shreveport, LA
National Provider Identifier
1992267611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 6010
- Practice address
- 4571 N Market St
Shreveport, LA 71107-2917 - Phone
- (318) 424-8973
- Fax
- (318) 424-8739
- NPI assigned
- Apr 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Case Manager/Care Coordinator | 171M00000X | 6010 | LA | Primary |
Addresses
Primary practice location
4571 N Market St
Shreveport, LA 71107-2917
Mailing address
10669 Willow Creek Rd
Moreno Valley, CA 92557-2953
Phone (951) 269-7988
Other practice location 1
136 E 6th St
Beaumont, CA 92223-2146
Phone (951) 845-3588
Other practice location 2
10669 Willow Creek Rd
Moreno Valley, CA 92557-2953
Phone (951) 269-7988
Other practice location 3
6711 Arlington Ave Ste C
Riverside, CA 92504-1966
Phone (951) 845-3588
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 |
|---|---|---|---|
| 6010 | LA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637625600000",
"number": "1992267611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10669 WILLOW CREEK RD",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925572953",
"telephone_number": "951-269-7988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4571 N MARKET ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711072917",
"telephone_number": "318-424-8973",
"fax_number": "318-424-8739"
}
],
"practiceLocations": [
{
"address_1": "136 E 6th St",
"address_purpose": "LOCATION",
"city": "Beaumont",
"state": "CA",
"postal_code": "922232146",
"country_code": "US",
"telephone_number": "951-845-3588",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10669 Willow Creek Rd",
"address_purpose": "LOCATION",
"city": "Moreno Valley",
"state": "CA",
"postal_code": "925572953",
"country_code": "US",
"telephone_number": "951-269-7988",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6711 Arlington Ave Ste C",
"address_purpose": "LOCATION",
"city": "Riverside",
"state": "CA",
"postal_code": "925041966",
"country_code": "US",
"telephone_number": "951-845-3588",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREEN",
"first_name": "JUANITA",
"middle_name": "ROSALYN",
"name_prefix": "Mrs.",
"credential": "PPS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-02",
"last_updated": "2021-11-23",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "LA",
"license": "6010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.