Provider Demographics
NPI:1184392672
Name:GROVES, KIMBERLY DAWN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:GROVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PANTHER MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:IAEGER
Mailing Address - State:WV
Mailing Address - Zip Code:24844-6200
Mailing Address - Country:US
Mailing Address - Phone:304-938-5156
Mailing Address - Fax:
Practice Address - Street 1:502 PANTHER MOHAWK RD
Practice Address - Street 2:
Practice Address - City:IAEGER
Practice Address - State:WV
Practice Address - Zip Code:24844-6200
Practice Address - Country:US
Practice Address - Phone:304-938-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant