Provider Demographics
NPI:1871058354
Name:GREER, ELLIS KATHRYN (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:ELLIS
Middle Name:KATHRYN
Last Name:GREER
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 RICHARD WAY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4422
Mailing Address - Country:US
Mailing Address - Phone:706-340-5652
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVE STE 130
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7600
Practice Address - Country:US
Practice Address - Phone:336-286-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC501163363LW0102X
NC000719367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
104606315OtherNATIONAL CERTIFICATION CORPORATION
NC000719OtherNORTH CAROLINA BOARD OF NURSING
CNM05164OtherAMERICAN MIDWIFERY CERTIFICATION BOARD
NC501163OtherNORTH CAROLINA BOARD OF NURSING