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ZANDRAL KEWAN GREEN
NPI 1124643069
Counselor - Mental Health in Vicksburg, MS

Active since June 16, 2020
3442 WISCONSIN AVE, VICKSBURG, MS 39180(601) 634-0181 Get Directions Write a Review

NPPES record last updated: June 30, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 30, 2020, Jun 16, 2020 (2 updates tracked since 2020).

About Zandral Kewan Green NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ZANDRAL KEWAN GREEN (NPI 1124643069) is an individual mental health provider in Vicksburg, Mississippi and active in the NPI registry since June 2020.

NPPES Registry Identity

NPI1124643069
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameZANDRAL KEWAN GREEN
Location Address3442 WISCONSIN AVEVicksburg, MS 39180-5331
Mailing Address4222 Commons CirVicksburg, MS 39180-5858 · (601) 702-9411
Phone(601) 634-0181
Sole ProprietorNo
Enumeration DateJune 16, 2020
Last NPPES UpdateJune 30, 20202 updates tracked since enumeration
NPPES CertifiedJune 30, 2020
✔ NPI 1124643069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
3442 WISCONSIN AVE, Vicksburg, MS 39180
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Other Identifiers 1

Medicaid00018215MS

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MELISSA DENISE BOWMAN LPN
Licensed Practical Nurse
3442 WISCONSIN AVE
VICKSBURG, MS 39180
Warren County (601) 634-0181

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Zandral Green's NPI number?

The NPI number for Zandral Green is 1124643069. It was assigned to this individual provider in the NPPES registry on June 16, 2020.

Where is Zandral Green located?

Zandral Green practices at 3442 Wisconsin Ave, Vicksburg, MS 39180. The listed phone number is (601) 634-0181.

What is Zandral Green's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Zandral Green was last updated on June 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.