Healthcare Provider Details

I. General information

NPI: 1356220651
Provider Name (Legal Business Name): GREENE ROOTS WELLNESS & TELEHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WOODLORE CIR
LITTLE ROCK AR
72211-2354
US

IV. Provider business mailing address

60 WOODLORE CIR
LITTLE ROCK AR
72211-2354
US

V. Phone/Fax

Practice location:
  • Phone: 501-563-8535
  • Fax:
Mailing address:
  • Phone: 501-747-7608
  • Fax: 888-496-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COREY LEE GREENE
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 501-563-8535