Provider Demographics
NPI:1356220651
Name:GREENE ROOTS WELLNESS & TELEHEALTH PLLC
Entity type:Organization
Organization Name:GREENE ROOTS WELLNESS & TELEHEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-563-8535
Mailing Address - Street 1:60 WOODLORE CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2354
Mailing Address - Country:US
Mailing Address - Phone:501-563-8535
Mailing Address - Fax:
Practice Address - Street 1:60 WOODLORE CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2354
Practice Address - Country:US
Practice Address - Phone:501-563-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty