JESSICA RHAE GROVE MSN, FNP-C, NPI 1093212094 — CUMBERLAND (MD)

NPI 1093212094

1+ Years Experience Individual

JESSICA RHAE GROVE MSN, FNP-C

04.07.2018
PROVIDER ENUMERATION DATE
03.05.2019
LAST UPDATE DATE
1093212094
NPI NUMBER

About JESSICA RHAE GROVE

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

JESSICA RHAE GROVE is a provider established in CUMBERLAND, MD. The NPI number of JESSICA RHAE GROVE is 1093212094 and was assigned on 04.07.2018. The practitioners primary taxonomy code is: 163WG0000X with license number: RN691701 PA .

Mailing address

  • City: CUMBERLAND
  • State: MD
  • Postal code: 215011671
  • Phone: 2409648342
  • Fax: 2409648337
  • Address: PO BOX 1671

Primary Practice Address

  • Region : CUMBERLAND, MD
  • NPI : 1093212094
  • Phone : 3017777300
  • Fax : 3017777121
  • Postalcode : 215023799
  • Address : 625 KENT AVE STE 204

Provider taxonomy - Registered Nurse

  • Taxonomy code: 163WG0000X
  • License number: RN691701
  • License state: PA

The taxonomy is not the primary taxonomy.

Healthcare provider taxonomy #2 - Nurse Practitioner

  • Taxonomy code: 363LF0000X
  • License number: SP018779
  • License state: PA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • JESSICA RHAE GROVE MSN, FNP-C
  • Address : 625 KENT AVE STE 204
  • Region : CUMBERLAND, MD
  • NPI : 1093212094
  • Phone : 3017777300
  • Fax : 3017777121
  • Postalcode : 215023799

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address625 KENT AVE STE 204
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCUMBERLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code215023799
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3017777300
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3017777121
The fax number associated with the location address of the provider being identified.
NPI1093212094
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1163WG0000X
Provider Enumeration Date04.07.2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated03.05.2019
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)JESSICA RHAE GROVE
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing AddressPO BOX 1671
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameCUMBERLAND
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code215011671
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number2409648342
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number2409648337
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1163WG0000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Registered Nurse
Provider License Number 1RN691701
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1PA
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2363LF0000X
Healthcare Provider Taxonomy 2Nurse Practitioner
Provider License Number 2SP018779
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2PA
Healthcare Provider Primary Taxonomy Switch 2Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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