Provider Demographics
NPI:1386636785
Name:GROVES, JOELENE (PA)
Entity Type:Individual
Prefix:MS
First Name:JOELENE
Middle Name:
Last Name:GROVES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-1236
Mailing Address - Country:US
Mailing Address - Phone:304-846-2573
Mailing Address - Fax:304-846-9562
Practice Address - Street 1:75 AVENUE B
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1236
Practice Address - Country:US
Practice Address - Phone:304-846-2573
Practice Address - Fax:304-846-9562
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP56838Medicare UPIN
WVGRPA76901Medicare ID - Type Unspecified