Healthcare Provider Details

I. General information

NPI: 1265643878
Provider Name (Legal Business Name): TIMOTHY M WEST PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 PENNSYLVANIA AVE
BARDSTOWN KY
40004-2529
US

IV. Provider business mailing address

100 E LIBERTY ST STE 800
LOUISVILLE KY
40202-1428
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-5685
  • Fax: 502-348-1771
Mailing address:
  • Phone: 502-540-3383
  • Fax: 502-540-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC6664
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: