Healthcare Provider Details

I. General information

NPI: 1467346213
Provider Name (Legal Business Name): SOPHIE MADELINE GROVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BANDAGE CT
MURRELLS INLET SC
29576-5103
US

IV. Provider business mailing address

140 BANDAGE CT
MURRELLS INLET SC
29576-5103
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.30993
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: