Healthcare Provider Details

I. General information

NPI: 1306252317
Provider Name (Legal Business Name): KENYA D GREENE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 W RANDOL MILL RD
ARLINGTON TX
76011-5738
US

IV. Provider business mailing address

536 W RANDOL MILL RD
ARLINGTON TX
76011-5738
US

V. Phone/Fax

Practice location:
  • Phone: 817-321-4716
  • Fax: 817-548-3997
Mailing address:
  • Phone: 817-321-4716
  • Fax: 817-548-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number142188
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: