Provider Demographics
NPI:1619301637
Name:GROTH, KARI (FNP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:GROTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4917
Mailing Address - Country:US
Mailing Address - Phone:817-692-7200
Mailing Address - Fax:
Practice Address - Street 1:1616 W. 21ST STREET, 1135 A-39
Practice Address - Street 2:
Practice Address - City:DFW AIRPORT
Practice Address - State:TX
Practice Address - Zip Code:75261
Practice Address - Country:US
Practice Address - Phone:972-425-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329103102Medicaid
TX329103101Medicaid
TX329103102Medicaid
TX329103101Medicaid