Healthcare Provider Details

I. General information

NPI: 1518085786
Provider Name (Legal Business Name): ANNA KIDDER WEST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

708 SPEARS AVE
CHATTANOOGA TN
37405-3537
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8050
  • Fax: 423-209-8052
Mailing address:
  • Phone: 423-756-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number66066
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: