Provider Demographics
NPI:1295718708
Name:GROVES, NICOLE KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KRISTINE
Last Name:GROVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DRIVE STE 5D
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-1700
Practice Address - Country:US
Practice Address - Phone:828-650-8032
Practice Address - Fax:828-650-8033
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43159208000000X
NC2011-01283208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34217700Medicaid
MN076318700Medicaid
MN076318700Medicaid
MN370002989Medicare PIN