Healthcare Provider Details

I. General information

NPI: 1710841077
Provider Name (Legal Business Name): KELLY MARIE GROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N RIVERVIEW ST STE 730
WICHITA KS
67203-4267
US

IV. Provider business mailing address

810 RUNNING HORSE LN
ARKANSAS CITY KS
67005-9391
US

V. Phone/Fax

Practice location:
  • Phone: 316-202-2110
  • Fax:
Mailing address:
  • Phone: 620-218-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW14394
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: