Provider Demographics
NPI:1881454601
Name:GREENE, COREY LEE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:LEE
Last Name:GREENE
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 711
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5309
Mailing Address - Country:US
Mailing Address - Phone:501-771-0674
Mailing Address - Fax:501-753-4174
Practice Address - Street 1:500 S UNIVERSITY AVE STE 711
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5309
Practice Address - Country:US
Practice Address - Phone:017-710-6745
Practice Address - Fax:501-753-4174
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR227525363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care