Healthcare Provider Details

I. General information

NPI: 1336830397
Provider Name (Legal Business Name): SYDNEY MARIE KACIK APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 VAN VOORHIS RD
MORGANTOWN WV
26505-3586
US

IV. Provider business mailing address

1075 VAN VOORHIS RD
MORGANTOWN WV
26505-3586
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-6216
  • Fax: 304-598-2602
Mailing address:
  • Phone: 304-598-6216
  • Fax: 304-598-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103523
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: