Healthcare Provider Details

I. General information

NPI: 1689594285
Provider Name (Legal Business Name): KYRA ALEXIS SHORT APRN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CEDAR RIDGE RD
BECKLEY WV
25801-2753
US

IV. Provider business mailing address

9 CEDAR RIDGE RD
BECKLEY WV
25801-2753
US

V. Phone/Fax

Practice location:
  • Phone: 304-923-1717
  • Fax:
Mailing address:
  • Phone: 304-923-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113418
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: