Individual
RODERICK GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-5815
(601) 984-5842
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5815
(601) 984-5842
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R828349
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09282029
—
MS
Enumeration date
04/03/2013
Last updated
07/29/2015
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