Healthcare Provider Details

I. General information

NPI: 1285515403
Provider Name (Legal Business Name): MISTY WEST PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 INDUSTRIAL DR
OWENSBORO KY
42301-8715
US

IV. Provider business mailing address

405 E 5TH ST
BEAVER DAM KY
42320-1979
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-6800
  • Fax:
Mailing address:
  • Phone: 270-202-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4043969
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: