Healthcare Provider Details

I. General information

NPI: 1336673912
Provider Name (Legal Business Name): KASIDY MCCOMBS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 3RD AVE
GALLIPOLIS OH
45631-1106
US

IV. Provider business mailing address

3987 JACKSON PIKE
GALLIPOLIS OH
45631-8440
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-4340
  • Fax:
Mailing address:
  • Phone: 740-441-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0038368
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number163221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: