Basic Information
Provider Information
NPI: 1518389584
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GROVES
FirstName: TASHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 ROSE ST
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405360001
CountryCode: US
TelephoneNumber: 8593235956
FaxNumber: 8593231080
Practice Location
Address1: 800 ROSE ST
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405360001
CountryCode: US
TelephoneNumber: 8593235956
FaxNumber: 8593231080
Other Information
ProviderEnumerationDate: 01/10/2014
LastUpdateDate: 07/31/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X3008362KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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