Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary Alexis K Green, PA-C

Individual provider Physician Assistant · NPI 1366436487

Mary Alexis K Green, PA-C is a Physician Assistant in Shreveport, Louisiana. Qualified in 2004, 22 years ago. Practices with Highland Clinic, a Prof Med Corp, a 60-clinician group and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
22
Licensed in
LA
In the registry since
2005
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1455 E Bert Kouns Industrial Loop Ste 210
Shreveport, LA 71105-6000
Phone: (318) 798-4623
Fax: (318) 798-4569
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA.200024 (LA)

Record details

NPI number1366436487
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 2, 2005
Last updated in NPPESFebruary 2, 2026
Certification dateFebruary 2, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Highland Clinic, A Prof Med Corp — 60 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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