Individual
REGINA D GROME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
143 PEYTON STREET, BARBOURSVILLE, WV 25504
(304) 697-2035
(304) 523-1485
Mailing address
PO BOX 4190, BARBOURSVILLE, WV 25504-4190
(304) 399-4405
(304) 399-2526
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00291
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001719144
MS BC/BS
—
01
—
110117516
RR MEDICARE
—
05
—
3810000471
—
WV
Enumeration date
02/13/2006
Last updated
04/09/2018
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