Provider Demographics
NPI:1871977140
Name:KIRK, CHASSITY (APRN-FNP-BC)
Entity type:Individual
Prefix:
First Name:CHASSITY
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5804
Practice Address - Street 1:5322 MCCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506-8725
Practice Address - Country:US
Practice Address - Phone:304-824-5707
Practice Address - Fax:304-824-5706
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810029997Medicaid
WVWV5964EMedicare PIN
WVWV5964B663Medicare PIN
WV3810029997Medicaid
WVWV5964BMedicare PIN
WVWV5964B662Medicare PIN
WVWV5964GMedicare PIN
WVWV5964DMedicare PIN
WVWV5964FMedicare PIN
WVWV5964AMedicare PIN