MEDICARE: MRS. KRISTIN MARIE GROVES RN, BSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1145446	TX

General Provider Information

NPI Number	:	1356693204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN MARIE GROVES RN, BSN, FNP-C

Provider Business Mailing Address
First Line	:	15 SMITH RD STE 3004
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5461
Country	:	US
Telephone Number	:	432-699-6000
Fax Number	:	432-699-6012

Provider Business Practice Location Address
First Line	:	15 SMITH RD STE 3004
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-5461
Country	:	US
Telephone Number	:	432-699-6000
Fax Number	:	432-699-6012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	12/21/2023

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