Healthcare Provider Details

I. General information

NPI: 1689807182
Provider Name (Legal Business Name): JAMES B WEST PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 05/12/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1484 LAKESIDE DR
JACKSON KY
41339-6555
US

IV. Provider business mailing address

PO BOX 690
BEATTYVILLE KY
41311-0690
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-9950
  • Fax: 606-666-9136
Mailing address:
  • Phone: 606-464-2401
  • Fax: 606-464-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5325
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1080
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: