Provider Demographics
NPI:1598480121
Name:GROOMS, KRISTI L
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:GROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:L
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1723 CARR RD
Mailing Address - Street 2:
Mailing Address - City:OSTRANDER
Mailing Address - State:OH
Mailing Address - Zip Code:43061-9765
Mailing Address - Country:US
Mailing Address - Phone:740-272-0504
Mailing Address - Fax:
Practice Address - Street 1:1723 CARR RD
Practice Address - Street 2:
Practice Address - City:OSTRANDER
Practice Address - State:OH
Practice Address - Zip Code:43061-9765
Practice Address - Country:US
Practice Address - Phone:740-272-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle