Healthcare Provider Details

I. General information

NPI: 1295030393
Provider Name (Legal Business Name): AMYE WILLIS GROVES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N SNEAD ST
BOAZ AL
35957-1763
US

IV. Provider business mailing address

PO BOX 720
BOAZ AL
35957-0720
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-5800
  • Fax: 256-840-5600
Mailing address:
  • Phone: 256-840-5800
  • Fax: 256-840-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-088716
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: