Provider Demographics
NPI:1942236690
Name:GROVES, PHILICIA MARIA (ARNP)
Entity Type:Individual
Prefix:
First Name:PHILICIA
Middle Name:MARIA
Last Name:GROVES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E VANDAMENT AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4949
Mailing Address - Country:US
Mailing Address - Phone:405-350-4300
Mailing Address - Fax:405-350-4302
Practice Address - Street 1:1029 E VANDAMENT AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4949
Practice Address - Country:US
Practice Address - Phone:405-350-4300
Practice Address - Fax:405-350-4302
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062152363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0062152OtherARNP LICENSURE