Provider Demographics
NPI:1689044950
Name:GROVE, SUSAN K (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:GROVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:SUGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1801 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3702
Mailing Address - Country:US
Mailing Address - Phone:972-262-5272
Mailing Address - Fax:972-262-1921
Practice Address - Street 1:1801 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3702
Practice Address - Country:US
Practice Address - Phone:972-262-5272
Practice Address - Fax:972-262-1921
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107780363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
456712YLPSOtherWMG MEDICARE