Provider Demographics
NPI:1962771097
Name:GROFF, KATHLEEN LOUISE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:GROFF
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6330 CASTLEPLACE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1902
Mailing Address - Country:US
Mailing Address - Phone:317-570-7900
Mailing Address - Fax:317-570-2288
Practice Address - Street 1:9302 N MERIDIAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1841
Practice Address - Country:US
Practice Address - Phone:317-570-7900
Practice Address - Fax:317-570-2288
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2016-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71003668A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201104000Medicaid
IN201104000Medicaid