Healthcare Provider Details

I. General information

NPI: 1407501547
Provider Name (Legal Business Name): CAITLIN LUARIE KIRK MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CAPITAL DR
CHILLICOTHEE OH
45601-1186
US

IV. Provider business mailing address

60 CAPITAL DR
CHILLICOTHEE OH
45601-1186
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4100
  • Fax: 740-779-4149
Mailing address:
  • Phone: 740-779-4100
  • Fax: 740-779-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030780
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: