Healthcare Provider Details

I. General information

NPI: 1184886335
Provider Name (Legal Business Name): KIMBERLY ANN WEST D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11521 FM 620 N
AUSTIN TX
78726-1139
US

IV. Provider business mailing address

11614 FM 2244 RD STE 130
AUSTIN TX
78738-5551
US

V. Phone/Fax

Practice location:
  • Phone: 512-402-6830
  • Fax:
Mailing address:
  • Phone: 512-263-3911
  • Fax: 512-263-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberN8312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: