Healthcare Provider Details

I. General information

NPI: 1154822278
Provider Name (Legal Business Name): SAMANTHA KIRK HYRE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA KIRK FRAME

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOYLMAN DR
GASSAWAY WV
26624-9318
US

IV. Provider business mailing address

100 HOYLMAN DR.
SUTTON WV
26601-9411
US

V. Phone/Fax

Practice location:
  • Phone: 304-364-5159
  • Fax: 304-364-5159
Mailing address:
  • Phone: 304-364-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number83745
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number83745
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: