Healthcare Provider Details

I. General information

NPI: 1235991597
Provider Name (Legal Business Name): KATLYN DANIELLE WEST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST STE 300
GREENSBORO NC
27401-1037
US

IV. Provider business mailing address

4024 SUMMER BROOK DR
APEX NC
27539-5705
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax:
Mailing address:
  • Phone: 919-210-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019485
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5019485
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5019485
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5019485
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: