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General NPI Number Information
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NPI Number | 1538051974
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Entity Type | Individual
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Provider Name | DEREK LEE GROVES RN
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Gender | Male
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1050 MILLCREEK DR
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City | HENDERSON
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State | KY
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Zip | 42420-5323
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Country | US
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Telephone | 812-475-9712
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 MILLCREEK DR
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City | HENDERSON
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State | KY
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Zip | 42420
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Country | US
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Telephone | 270-454-4914
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Fax |
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 28264125A
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License Number State | IN
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