Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN256618 | GA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN256618 | GA |
NPI | 1003312984 |
---|---|
Provider Name | Kathleen Meera Groff |
First Address | Fort Campbell, KY 42223-5318 |
Second Address | Fort Campbell, KY 42223-5318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2018 |
Last Update Date | 22/01/2020 |