Provider Demographics
NPI:1013356757
Name:GROH, KEVIN EUGENE (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:EUGENE
Last Name:GROH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 HICKORY HOLLOW PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3389
Mailing Address - Country:US
Mailing Address - Phone:615-891-2070
Mailing Address - Fax:615-891-2056
Practice Address - Street 1:5380 HICKORY HOLLOW PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013
Practice Address - Country:US
Practice Address - Phone:615-891-2070
Practice Address - Fax:615-891-2056
Is Sole Proprietor?:No
Enumeration Date:2013-06-16
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23034363A00000X
TN3489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant