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Individual

JENNIFER G. GROVES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C.

Contact information

Practice address
6301 HARRIS PKWY STE 300, FORT WORTH, TX 76132-4266
(817) 877-3432
Mailing address
PO BOX 75420, BALTIMORE, MD 21275-5420
(703) 383-6469
(703) 385-1062

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110005261
VA
363A00000X
Physician Assistant
10001825A
IN
363A00000X
Physician Assistant
10001825B
IN
363A00000X
Physician Assistant
99066589A
IN
363A00000X
Physician Assistant
Primary
PA15632
TX
363A00000X
Physician Assistant
PA901
KY
363A00000X
Physician Assistant
DC
363AM0700X
Medical Physician Assistant
PA901
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201162650
IN
01
36000818
ASC MEDICAID GROUP
KY
01
37903705
MEDICAID LAB GROUP
KY
01
4000501
MEDICARE LAB GROUP
KY
05
95005351
KY
01
ASC1019
ASC MEDICARE
KY
01
CB5773
RR GROUP NO
KY
01
P00379405
RR MEDICARE PIN
KY
Enumeration date
10/05/2006
Last updated
08/18/2023
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