Healthcare Provider Details

I. General information

NPI: 1134393929
Provider Name (Legal Business Name): KELLY LEIGH WEST M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 NEW GARDEN ROAD SUITE 106
GREENSBORO NC
27410-2567
US

IV. Provider business mailing address

2006 NEW GARDEN ROAD SUITE 106
GREENSBORO NC
27410-2567
US

V. Phone/Fax

Practice location:
  • Phone: 336-609-6240
  • Fax:
Mailing address:
  • Phone: 336-609-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2012-00163
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: