MEDICARE: KENYA D GREENE LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	142188	TX

General Provider Information

NPI Number	:	1306252317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA D GREENE LVN

Provider Business Mailing Address
First Line	:	536 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5738
Country	:	US
Telephone Number	:	817-321-4716
Fax Number	:	817-548-3997

Provider Business Practice Location Address
First Line	:	536 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5738
Country	:	US
Telephone Number	:	817-321-4716
Fax Number	:	817-548-3997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	07/10/2014

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