Provider Demographics
NPI:1568879823
Name:GROOMS, CHARLIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:GROOMS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 754
Mailing Address - Street 2:SMOKY MTN. HOME HEALTH AND HOSPICE
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37822-0754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-4200
Practice Address - Country:US
Practice Address - Phone:423-581-8140
Practice Address - Fax:423-581-8131
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner