Provider Demographics
NPI:1073243325
Name:ACKERMAN, CASIE (APRN)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3722
Mailing Address - Country:US
Mailing Address - Phone:304-691-1930
Mailing Address - Fax:
Practice Address - Street 1:1934 11TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3722
Practice Address - Country:US
Practice Address - Phone:304-529-0900
Practice Address - Fax:304-529-3913
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015582363L00000X
WV113673363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner