Healthcare Provider Details

I. General information

NPI: 1295718708
Provider Name (Legal Business Name): NICOLE KRISTINE GROVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 US HIGHWAY 70 W
BLACK MOUNTAIN NC
28711-5526
US

IV. Provider business mailing address

3176 US HIGHWAY 70 W
BLACK MOUNTAIN NC
28711-5526
US

V. Phone/Fax

Practice location:
  • Phone: 828-419-0483
  • Fax: 828-740-2914
Mailing address:
  • Phone: 828-419-0483
  • Fax: 828-740-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43159
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011-01283
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: