Individual
CORTNI GROOMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8040 CLEARVISTA PKWY STE 310, INDIANAPOLIS, IN 46256-4673
(317) 621-2200
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002451A
IN
363A00000X
Physician Assistant
99085963A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300014618
—
IN
Enumeration date
05/01/2018
Last updated
08/20/2024
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