Healthcare Provider Details

I. General information

NPI: 1508677022
Provider Name (Legal Business Name): KATHRYN WEST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 HIGHWAY 42 S STE 110
LOCUST GROVE GA
30248-3039
US

IV. Provider business mailing address

3920 ARKWRIGHT RD STE 415
MACON GA
31210-1731
US

V. Phone/Fax

Practice location:
  • Phone: 770-898-4339
  • Fax:
Mailing address:
  • Phone: 678-752-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN270289
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: