Provider Demographics
NPI:1093238123
Name:GROVE, KRISTEN NOELLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NOELLE
Last Name:GROVE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13251 FALLS OF NEUSE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8573
Mailing Address - Country:US
Mailing Address - Phone:919-785-5055
Mailing Address - Fax:919-573-6689
Practice Address - Street 1:13251 FALLS OF NEUSE RD STE 121
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-785-5055
Practice Address - Fax:919-573-6689
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009730363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health