Healthcare Provider Details

I. General information

NPI: 1992067375
Provider Name (Legal Business Name): KELSEY DIANE WEST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY DIANE WORTHINGTON MD

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 17TH ST BRIGHAM BLDG MS 316
RENO NV
89557-3050
US

IV. Provider business mailing address

1664 N VIRGINIA ST # MS -1332
RENO NV
89557-0001
US

V. Phone/Fax

Practice location:
  • Phone: 775-784-1533
  • Fax: 775-784-8075
Mailing address:
  • Phone: 775-682-8175
  • Fax: 775-327-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17524
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: