Casey Kwak, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024185947 Issued in VA

Practice address

3554 Chain Bridge Rd Ste 200
Fairfax, VA 22030-2709

Phone

(703) 896-7628

NPI assigned

Dec 8, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairfax Mental Health & Wellness

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1699201749
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735430400000",
    "number": "1134830425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3554 CHAIN BRIDGE RD STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3554 CHAIN BRIDGE RD STE 200",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302709",
            "telephone_number": "703-896-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAK",
        "first_name": "CASEY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-08",
        "last_updated": "2024-12-29",
        "certification_date": "2024-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024185947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Edwin Kuperstock, M.D.
• Emily Kurinsky
• Minami Kurose, OD
• Robert N Kurtzke, M.D.
• Yuka Kuwahara
• Myoung Kwak, MD
• Caroline Kwon, MD
• Yoo Rhee Kwon, FNP-BC
• Christopher Douglas Kyle, CRNA
• Elizabeth Ann Kyser, PHD

• All providers in Fairfax, VA
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.