Individual
KEISHA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2616 GENERAL PATTON ST, LAKE CHARLES, LA 70615-8116
(337) 425-2085
Mailing address
2616 GENERAL PATTON ST, LAKE CHARLES, LA 70615-8116
(337) 425-2085
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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