Healthcare Provider Details

I. General information

NPI: 1902714066
Provider Name (Legal Business Name): RUTH ANN GROFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S DIVISION ST
LAVACA AR
72941-3220
US

IV. Provider business mailing address

300 PRAIRIE ST
CHARLESTON AR
72933-9225
US

V. Phone/Fax

Practice location:
  • Phone: 479-377-1232
  • Fax: 479-377-1233
Mailing address:
  • Phone: 479-965-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRNR037970
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: