Individual
DESTINY GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1012 CENTER DR, RICHMOND, KY 40475-3838
(859) 626-9696
Mailing address
PO BOX 267, RICHMOND, KY 40476-0267
(859) 626-9696
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4024428
KY
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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