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General NPI Number Information
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NPI Number | 1356220651
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Entity Type | Organization
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Legal Business Name | GREENE ROOTS WELLNESS & TELEHEALTH PLLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 60 WOODLORE CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2354
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Country | US
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Telephone | 501-563-8535
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Fax |
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Provider Business Mailing Address
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Address Line | 60 WOODLORE CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2354
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Country | US
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Telephone | 501-747-7608
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Fax | 888-496-4627
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | COREY LEE GREENE
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Credential | APRN
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Telephone | 501-563-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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