Provider Demographics
NPI:1073891867
Name:FAZIO, KIRBY MAE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KIRBY
Middle Name:MAE
Last Name:FAZIO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:KIRBY
Other - Middle Name:MAE
Other - Last Name:DRUSCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STUDENT
Mailing Address - Street 1:PO BOX 6230
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:304-242-7106
Mailing Address - Fax:304-242-7108
Practice Address - Street 1:90 N 4TH ST
Practice Address - Street 2:SUITE 300N
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-4765
Practice Address - Fax:740-633-6450
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV71224163W00000X, 390200000X, 363L00000X, 363LF0000X
OHRN.374015363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021489Medicaid
WVWV0588AMedicare Oscar/Certification
OHH047400Medicare Oscar/Certification