Healthcare Provider Details

I. General information

NPI: 1093238123
Provider Name (Legal Business Name): KRISTEN NOELLE GROVE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 KEMPTHORNE RD
CARY NC
27519-8977
US

IV. Provider business mailing address

2814 KEMPTHORNE RD
CARY NC
27519-8977
US

V. Phone/Fax

Practice location:
  • Phone: 919-883-2283
  • Fax: 919-655-1377
Mailing address:
  • Phone: 919-883-2283
  • Fax: 919-655-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5009730
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: