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General NPI Number Information
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NPI Number | 1356068894
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Entity Type | Individual
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Provider Name | ABIGAIL GROOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1326 CLARKSON CLAYTON CTR
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City | ELLISVILLE
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State | MO
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Zip | 63011-2145
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Country | US
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Telephone | 314-293-4410
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Fax | 314-293-4412
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Provider Business Mailing Address
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Address Line | 1326 CLARKSON CLAYTON CTR
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City | ELLISVILLE
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State | MO
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Zip | 63011-2145
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Country | US
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Telephone | 314-293-4410
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Fax | 314-293-4412
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2022037498
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License Number State | MO
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