Healthcare Provider Details

I. General information

NPI: 1750621496
Provider Name (Legal Business Name): VANESSA A WEST ATC, LAT, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 02/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18333 HIGHWAY 182
BALDWIN LA
70514-1449
US

IV. Provider business mailing address

125 RIDGEVIEW DR APT H6
BROUSSARD LA
70518-5049
US

V. Phone/Fax

Practice location:
  • Phone: 337-924-7990
  • Fax:
Mailing address:
  • Phone: 225-715-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH.200063
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: