Provider Demographics
NPI:1134242415
Name:GROTHER, JOAN PRISCILLA (APRN)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:PRISCILLA
Last Name:GROTHER
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 1:1301 W 12TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2589
Mailing Address - Country:US
Mailing Address - Phone:620-342-2900
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2589
Practice Address - Country:US
Practice Address - Phone:620-342-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45855363LW0102X, 363LF0000X
KS45855363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200427960AMedicaid
KS200427960AMedicaid
NCQ15518Medicare UPIN