Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | APN24485 | TN |
NPI | 1336628031 |
---|---|
Provider Name | Kathy Grove |
First Address | Hermitage, TN 37076-2056 |
Second Address | Hermitage, TN 37076-2056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |