Healthcare Provider Details

I. General information

NPI: 1790346484
Provider Name (Legal Business Name): MITCHELL W WEST PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4429
  • Fax: 859-276-5919
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-276-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2711
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: