Raven Rock Health &Wellness

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

RAVEN ROCK HEALTH &WELLNESS

Practice address

101 N Main St
Stanton, KY 40380-2174

Phone

(859) 497-9508

NPI assigned

Mar 15, 2022

Last updated

Jun 10, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Georgette Lee Greene, APRNNPI 1700322385

Title

Managing Member

Phone

(606) 775-0515

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Georgette Greene, APRN

  • Family Nurse Practitioner
  • Stanton, KY
  • NPI 1700322385
  Authorized official Same address or phone
• Lisa Carol Clem, LCSW

  • Social Worker
  • Mt Sterling, KY
  • NPI 1750786885
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686355200000",
    "number": "1144978594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N MAIN ST",
            "city": "STANTON",
            "state": "KY",
            "postal_code": "403802174",
            "telephone_number": "606-775-0515",
            "fax_number": "606-775-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N MAIN ST",
            "city": "STANTON",
            "state": "KY",
            "postal_code": "403802174",
            "telephone_number": "859-497-9508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVEN ROCK HEALTH &WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2023-06-10",
        "certification_date": "2023-06-10",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "GEORGETTE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "606-775-0515",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100897870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Powell County Health Department
• Powell County Health Department (Stanton Elementary)
• Powell County Schools
• Prostep Rehabilitation
• Glenn Riego Puertollano, MD
• Raven Rock Wellness Center LLC
• Red River Behavioral Health, LLC
• Regional Physicians Corporation II (Powell County Clinic)
• Jennifer Marie Reynolds, OT
• Shellie Roberts, CSW

• Primary Care Clinic/Center in Stanton, KY
• Providers in Stanton, KY by specialty
• Primary Care Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.