Healthcare Provider Details

I. General information

NPI: 1306766704
Provider Name (Legal Business Name): MIRANDA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CANTERBURY RD
SMITHFIELD NC
27577-4861
US

IV. Provider business mailing address

97 N FARM HORSE TRL
SMITHFIELD NC
27577-6501
US

V. Phone/Fax

Practice location:
  • Phone: 919-594-0487
  • Fax:
Mailing address:
  • Phone: 919-594-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07260908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: