Individual
KENNETH JUSTIN GROVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
620 W HAYS ST, BOISE, ID 83702-5511
(208) 381-2094
(208) 381-1791
Mailing address
PO BOX 1616, EVANSVILLE, IN 47706-0018
(800) 672-7210
(541) 758-3713
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/24/2022
Last updated
09/07/2023
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