Provider Demographics
NPI:1093144628
Name:GROVES, JULIE A (APRNCNS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GROVES
Suffix:
Gender:F
Credentials:APRNCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:405-951-4372
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-947-3341
Practice Address - Fax:405-951-4372
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75514364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK355310YSGZMedicare PIN