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General NPI Number Information
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NPI Number | 1891769485
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Entity Type | Individual
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Provider Name | REGINA D GROME PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 143 PEYTON STREET
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City | BARBOURSVILLE
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State | WV
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Zip | 25504
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Country | US
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Telephone | 304-697-2035
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Fax | 304-523-1485
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Provider Business Mailing Address
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Address Line | PO BOX 4190
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-4190
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Country | US
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Telephone | 304-399-4405
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Fax | 304-399-2526
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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 | 00291
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License Number State | WV
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