Provider Demographics
NPI:1972275485
Name:KIRK, CHERYL DENISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5862 LEGG FORK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25320
Mailing Address - Country:US
Mailing Address - Phone:304-514-9873
Mailing Address - Fax:
Practice Address - Street 1:5862 LEGG FORK ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25320
Practice Address - Country:US
Practice Address - Phone:304-514-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily