KELLYE F GREEN (NPI# 1871104810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1871104810 |
Entity Type | Individual |
Full Name | KELLYE F GREEN |
Other Name | KELLYE F FERGUSON |
Practice Address |
111 N Hudson St Altus OK 73521-3811 |
Mailing Address |
4400 N Lincoln Blvd Oklahoma City OK 73105-5104 |
Practice Telephone | 5803794085 |
Mailing Telephone | 5803794085 |
Enumeration Date | 2020-08-13 |
Last Update Date | 2020-08-13 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 175T00000X | Peer Specialist | Other Service Providers |
Street Address |
111 N HUDSON ST |
City | ALTUS |
State | OK |
Zip Code | 73521-3811 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336259399 | Sonya Michelle Mcauliffe | Counselor | 111 N Hudson St, Altus, OK 73521-3811 | 2006-08-30 |
1295342350 | Kolton Sanders | Counselor | 111 N Hudson St, Altus, OK 73521-3811 | 2020-09-23 |
1942834114 | Nicole Marie Nguyen | Case Manager/Care Coordinator | 111 N Hudson St, Altus, OK 73521-3811 | 2020-02-26 |
1639733884 | Jenne Gough | Registered Nurse | 111 N Hudson St, Altus, OK 73521-3811 | 2019-04-23 |
1871055764 | Abigail Graham | Case Manager/Care Coordinator | 111 N Hudson St, Altus, OK 73521-3811 | 2019-04-01 |
1366948895 | Melody Dianne Tollison | Peer Specialist | 111 N Hudson St, Altus, OK 73521-3811 | 2018-04-03 |
1598277808 | Jill Leighann Hodges | Counselor | 111 N Hudson St, Altus, OK 73521-3811 | 2017-10-26 |
1780195404 | Wendy Mae Clouse | Counselor | 111 N Hudson St, Altus, OK 73521-3811 | 2017-10-20 |
1164948808 | Dana Rae Winters | Counselor | 111 N Hudson St, Altus, OK 73521-3811 | 2017-08-15 |
1982128906 | Kayla Jean Causey | Counselor | 111 N Hudson St, Altus, OK 73521-3811 | 2017-08-01 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982263752 | Shortgrass Community Health Center, Inc | Clinic/Center | 211 East Broadway, Altus, OK 73521 | 2019-06-06 |
1598025827 | Dustin James Robins | Counselor | 1052 E Cherry St, Altus, OK 73521 | 2012-05-21 |
1831471101 | Manda Lea Stephens | Nurse Practitioner | 205 S. Park Lane, Altus, OK 73521 | 2011-09-13 |
1649439167 | Lisa Michelle Shelton | Pharmacist | 2500 N Main, Altus, OK 73521 | 2008-06-09 |
1114192911 | Richard G. Henry | Health Maintenance Organization | 112 Val Verde, Altus, OK 73521 | 2008-04-23 |
1194881060 | Resters Diabetic Shoes and Home Medical | Durable Medical Equipment & Medical Supplies | 103 West Commerce Street, Altus, OK 73521 | 2006-12-28 |
1265592141 | Noble L Ballard.medical Clinic, Pllc | Family Medicine | 1015 East Broadway Street, Stuite 101, Altus, OK 73521 | 2006-12-11 |
1457377822 | Comanche County Healthcare | Family Medicine | 3000 N Main St, Suite A, Altus, OK 73521 | 2006-07-15 |
1326095381 | Charles C Carter Md Dph Pllc | Family Medicine | 1015 E Broadway St, Suite 102, Altus, OK 73521 | 2006-05-27 |
1013988179 | Carol Marie Sherman | Family Medicine | 205 S Park Ln, Altus, OK 73521 | 2006-01-27 |
Find all providers in zip 73521 |
Taxonomy Code | 175T00000X |
Grouping | Other Service Providers |
Classification | Peer Specialist |
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609273358 | Kimberly Ruth Richardson | Peer Specialist | 1012 E Cherry St, Altus, OK 73521-6402 | 2014-11-24 |
1366948895 | Melody Dianne Tollison | Peer Specialist | 111 N Hudson St, Altus, OK 73521-3811 | 2018-04-03 |
1043748361 | Joshua Caleb Lorah | Peer Specialist | 123 W Commerce St Fl 5, Altus, OK 73521-3850 | 2017-05-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659972537 | Tamra Lynn Cunningham | Peer Specialist | 764 Sherwin Ave, Ponca City, OK 74604-6112 | 2020-11-05 |
1699375691 | Martha Isabel Zapata | Peer Specialist | 5740 E 72nd Ct, Tulsa, OK 74136-7202 | 2020-10-28 |
1376143883 | Tina Marie Lopez | Peer Specialist | 933 N Oak St, Ponca City, OK 74601-3218 | 2020-10-26 |
1518566264 | Vincent Oaks Cox | Peer Specialist | 3585 S 439, Pryor, OK 74361-9346 | 2020-10-23 |
1558960146 | Sarah Elizabeth Walters | Peer Specialist | 2139 W Jasper St Apt B1, Broken Arrow, OK 74011-8028 | 2020-10-23 |
1861091548 | Ryan Vanmeter | Peer Specialist | 1965 Ladera Ln, Edmond, OK 73034-9787 | 2020-10-22 |
1255930038 | Brandon Loyd Hopkins | Peer Specialist | 446 S Scraper St, Vinita, OK 74301-4250 | 2020-10-22 |
1225637366 | Crystal Dawn Adams | Peer Specialist | 200 N Sante Fe Ave, Bartlesville, OK 74003 | 2020-10-20 |
1194324491 | Judith Anne Young | Peer Specialist | 3934 Se 27th St, Del City, OK 73115-2620 | 2020-10-19 |
1407455892 | Kristen Michelle Stock | Peer Specialist | 804 N Dryden Cir, Stillwater, OK 74075-7108 | 2020-10-18 |
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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.