Individual
MS. COLLEEN DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
1108 ROSS CLARK CIR FL 4, DOTHAN, AL 36301-3022
(334) 699-4300
Mailing address
5224 75TH ST STE D, LUBBOCK, TX 79424-2525
(806) 712-1096
(806) 771-2093
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11248938-1206
UT
363A00000X
Physician Assistant
Primary
PA.2444
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/12/2020
Last updated
08/21/2024
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