Healthcare Provider Details

I. General information

NPI: 1821893033
Provider Name (Legal Business Name): KARLA ANN GROAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10825 TOWNSHIP ROAD 49
MOUNT PERRY OH
43760-9779
US

IV. Provider business mailing address

533 GROAH RD
STOCKPORT OH
43787-9373
US

V. Phone/Fax

Practice location:
  • Phone: 740-221-6550
  • Fax: 833-949-3972
Mailing address:
  • Phone: 740-624-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0034900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: