Provider Demographics
NPI:1932445079
Name:KIRK, HEATHER ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
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 1:557 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3809
Mailing Address - Country:US
Mailing Address - Phone:304-752-3436
Mailing Address - Fax:304-687-2669
Practice Address - Street 1:557 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3809
Practice Address - Country:US
Practice Address - Phone:304-752-3436
Practice Address - Fax:304-687-2669
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily