Individual
KAYLA GROOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2511 W EDGEWOOD DR, JEFFERSON CITY, MO 65109-5869
(573) 761-0304
Mailing address
163 OPIE RD, EUGENE, MO 65032-4029
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2021019395
MO
Other
Enumeration date
06/01/2021
Last updated
07/10/2021
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