Healthcare Provider Details

I. General information

NPI: 1972293603
Provider Name (Legal Business Name): ZOE GROOMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 S MOONEY BLVD
VISALIA CA
93277-6228
US

IV. Provider business mailing address

107 FAIRLAWN RD
LOUISVILLE KY
40207-2905
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 502-963-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number65325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: