Individual
MARY ALEXIS K GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1455 E BERT KOUNS INDUSTRIAL LOOP STE 210, SHREVEPORT, LA 71105-6000
(318) 798-4623
(318) 798-4569
Mailing address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4623
(318) 798-4646
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200024
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053315846
GROUP NPI NUMBER
LA
05
—
1626244
—
LA
01
—
P00245408
RAILROAD MEDICARE NUMBER
LA
Enumeration date
09/02/2005
Last updated
02/02/2026
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