Provider Demographics
NPI:1104822618
Name:GROOM, HOLLIS A (CNM)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:A
Last Name:GROOM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 S MAYHILL RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5910
Mailing Address - Country:US
Mailing Address - Phone:940-591-6700
Mailing Address - Fax:940-320-1220
Practice Address - Street 1:4370 MEDICAL ARTS DR STE 300
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1724
Practice Address - Country:US
Practice Address - Phone:940-591-6700
Practice Address - Fax:940-320-1220
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX550830367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090068004Medicaid
S10006Medicare UPIN