# GRACEFULLY RENEWED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043121205
- **Authorized official:** CHASSITY R KIRK APRN,FNP-BC (NURSE PRACTITIONER)
- **Authorized official phone:** (304) 305-3662

## Contact information

- **Practice address:** 74 ALFORD BR, HARTS, WV 25524-8700
- **Practice address phone:** (304) 305-3662
- **Mailing address:** 74 ALFORD BR, HARTS, WV 25524-8700
- **Mailing address phone:** (304) 305-3662

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2026
- **Last updated:** 09/16/2026