Provider Demographics
NPI:1194214619
Name:VLKOJAN GROVE, KRISTA JO (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:JO
Last Name:VLKOJAN GROVE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:JO
Other - Last Name:VLKOJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:650 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8947
Mailing Address - Country:US
Mailing Address - Phone:724-438-4364
Mailing Address - Fax:724-438-4720
Practice Address - Street 1:650 CHERRY TREE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-438-4364
Practice Address - Fax:724-438-4720
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner