MRS. KIM CLARK-GREEN (NPI# 1043875263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043875263 |
| Entity Type | Individual |
| Full Name | MRS. KIM CLARK-GREEN |
| Practice Address |
4111 Metro Dr Ste B Shreveport LA 71109-6001 |
| Practice Telephone | 3186360390 |
| Practice Fax Number | 3186353298 |
| Mailing Telephone | 3186360390 |
| Mailing Fax Number | 3186353298 |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2019-05-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
4111 METRO DR STE B |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71109-6001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700359379 | Donna L Brooks | Counselor | 4111 Metro Dr Ste B, Shreveport, LA 71109-6001 | 2019-01-07 |
| 1629532460 | Rickey Harris | Case Manager/Care Coordinator | 4111 Metro Dr Ste B, Shreveport, LA 71109-6001 | 2019-01-25 |
| 1669945986 | Melvin Lars | Counselor | 4111 Metro Dr Ste B, Shreveport, LA 71109-6001 | 2019-01-09 |
| 1124591706 | Eunice Wilkerson | Counselor | 4111 Metro Dr Ste B, Shreveport, LA 71109-6001 | 2019-01-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548784416 | Barbara Smith | Counselor | 4019 Greenwood Road, Shreveport, LA 71109 | 2017-08-01 |
| 1508306135 | Cherise Sims | Case Manager/Care Coordinator | 3512 Greenbriar Dr, Shreveport, LA 71109 | 2017-03-01 |
| 1174063093 | Nitika Pinesett | Case Manager/Care Coordinator | 3011 Independence Ave, Shreveport, LA 71109 | 2017-02-24 |
| 1831640986 | Aleric Hamilton | Counselor | 2605 Leaf Ln, Shreveport, LA 71109 | 2016-10-24 |
| 1144673963 | Lakeishia Johnson | Technician | 5342 Broadway Ave, Shreveport, LA 71109 | 2016-07-16 |
| 1083074223 | Patricia Pouncy | Counselor | 4019 Greenwood Rd, Shreveport, LA 71109 | 2016-03-01 |
| 1326418518 | Deepasulochana Sivasankaraganesan | Dentist | 3719 Jewella Ave, Shreveport, LA 71109 | 2015-09-30 |
| 1063611838 | Della Edwards Wills | Social Worker | 4615 Monkhouse Drive, Ste A-2-b, Shreveport, LA 71109 | 2007-07-12 |
| 1083743041 | An Endless Love Home Care, LLC | Point of Service | 6259 Tinker Street, Shreveport, LA 71109 | 2007-03-05 |
| 1316009624 | Djenane Rousseau | Pharmacist | 4140 Hollywood, Shreveport, LA 71109 | 2006-12-14 |
| Find all providers in zip 71109 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497360887 | Halena Jones | Case Manager/Care Coordinator | 9409 Chaparral Ln, Shreveport, LA 71118-4337 | 2020-09-11 |
| 1598376196 | Michaela Nicole Bradley | Case Manager/Care Coordinator | 10021 Stratmore Cir, Shreveport, LA 71115-3416 | 2020-08-17 |
| 1619585791 | Kimberly Bissell | Case Manager/Care Coordinator | 7505 Pines Rd Ste 1115, Shreveport, LA 71129-3900 | 2020-07-15 |
| 1902414170 | Unique Lashae Lister | Case Manager/Care Coordinator | 2611 Corbitt St, Shreveport, LA 71108-2805 | 2020-07-14 |
| 1407474828 | Angela Harris | Case Manager/Care Coordinator | 1111 W 70th St Apt 93, Shreveport, LA 71106-3558 | 2020-07-13 |
| 1669096921 | Ryan Barham | Case Manager/Care Coordinator | 824 Oneonta St, Shreveport, LA 71106-1130 | 2020-06-02 |
| 1922621085 | Julian White | Case Manager/Care Coordinator | 8529 Grover Pl, Shreveport, LA 71115-2707 | 2020-05-24 |
| 1396368817 | Shannon Marie Cannon | Case Manager/Care Coordinator | 1543 Summers St, Shreveport, LA 71108-3131 | 2020-05-19 |
| 1730701954 | Brianna Mason | Case Manager/Care Coordinator | 1533 Marshall St, Shreveport, LA 71101-3941 | 2020-05-11 |
| 1295355238 | Angela Rice | Case Manager/Care Coordinator | 2704 Frostwood Dr, Shreveport, LA 71108-5524 | 2020-04-20 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.