Healthcare Provider Details

I. General information

NPI: 1669012761
Provider Name (Legal Business Name): KEVIN ANDREW WEST NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W FLEMING DR
MORGANTON NC
28655-4450
US

IV. Provider business mailing address

695 W FLEMING DR
MORGANTON NC
28655-4450
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-3278
  • Fax: 828-580-3279
Mailing address:
  • Phone: 828-580-3278
  • Fax: 828-580-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012769
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: