Provider Demographics
NPI:1932102019
Name:GROPP, KIMBERLY A (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:GROPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6098
Mailing Address - Country:US
Mailing Address - Phone:203-869-6960
Mailing Address - Fax:203-869-5103
Practice Address - Street 1:75 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6098
Practice Address - Country:US
Practice Address - Phone:203-869-6960
Practice Address - Fax:203-869-5103
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001693363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400001380OtherMEDICARE - UNSPECIFIED
CT004188828Medicaid
CTD400001380OtherMEDICARE - UNSPECIFIED
CT0400001380Medicare NSC
CTS43780Medicare UPIN