Provider Demographics
NPI:1013346196
Name:GROVER, KRISTIN MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:GROVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:MICHELE
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5 BROOKWOOD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9576
Mailing Address - Country:US
Mailing Address - Phone:717-249-2424
Mailing Address - Fax:717-249-4534
Practice Address - Street 1:5 BROOKWOOD AVE STE 1
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9576
Practice Address - Country:US
Practice Address - Phone:717-249-2424
Practice Address - Fax:717-249-4534
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056305363AM0700X
PAOA003099363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103383089Medicaid