Provider Demographics
NPI:1356068894
Name:GROOS, ABIGAIL (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:GROOS
Suffix:
Gender:F
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 1:1326 CLARKSON CLAYTON CTR
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2145
Mailing Address - Country:US
Mailing Address - Phone:314-293-4410
Mailing Address - Fax:314-293-4412
Practice Address - Street 1:1326 CLARKSON CLAYTON CTR
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2145
Practice Address - Country:US
Practice Address - Phone:314-293-4410
Practice Address - Fax:314-293-4412
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022037498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant