Healthcare Provider Details

I. General information

NPI: 1326963125
Provider Name (Legal Business Name): TABITHA LYNN GROVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S CHESTNUT ST
COPAN OK
74022-4020
US

IV. Provider business mailing address

306 S CHESTNUT ST
COPAN OK
74022-4020
US

V. Phone/Fax

Practice location:
  • Phone: 620-264-6442
  • Fax:
Mailing address:
  • Phone: 620-264-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number230579
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: