Provider Demographics
NPI:1093591752
Name:GROVES, DELACEY
Entity Type:Individual
Prefix:
First Name:DELACEY
Middle Name:
Last Name:GROVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WESTPORT RD APT 8A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2801
Mailing Address - Country:US
Mailing Address - Phone:270-401-9847
Mailing Address - Fax:
Practice Address - Street 1:202 BISHOP LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9266
Practice Address - Country:US
Practice Address - Phone:270-234-0003
Practice Address - Fax:270-360-0840
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist