Provider Demographics
NPI:1841984358
Name:GROGAN, KRISTI ANNELIES (AE)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANNELIES
Last Name:GROGAN
Suffix:
Gender:F
Credentials:AE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2050
Mailing Address - Country:US
Mailing Address - Phone:859-800-0445
Mailing Address - Fax:
Practice Address - Street 1:256 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2050
Practice Address - Country:US
Practice Address - Phone:859-800-0445
Practice Address - Fax:859-309-5493
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier