1962618033 NPI number — HOLLY ANNETTE GROVES APRN, FNP-C, RD, LD

Table of content: HOLLY ANNETTE GROVES APRN, FNP-C, RD, LD (NPI 1962618033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962618033 NPI number — HOLLY ANNETTE GROVES APRN, FNP-C, RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROVES
Provider First Name:
HOLLY
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C, RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962618033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3999 BARDS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42345-4708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-543-1730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42220-8812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-265-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1235 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 3013212 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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