Provider Demographics
NPI:1902368921
Name:GROOVER, KIRBY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:MARIE
Last Name:GROOVER
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 1:200 HARRIS LN
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8508
Mailing Address - Country:US
Mailing Address - Phone:615-887-7080
Mailing Address - Fax:
Practice Address - Street 1:890 ISABELLA LN
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4215
Practice Address - Country:US
Practice Address - Phone:615-768-8021
Practice Address - Fax:615-768-8022
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant