Healthcare Provider Details

I. General information

NPI: 1740340603
Provider Name (Legal Business Name): KRISTIN MICHELLE WEST ATC-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 500 E #130
LOGAN UT
84341-2408
US

IV. Provider business mailing address

262 W 1000 N
LOGAN UT
84321-2211
US

V. Phone/Fax

Practice location:
  • Phone: 435-716-2882
  • Fax: 435-716-2809
Mailing address:
  • Phone: 435-753-3585
  • Fax: 435-716-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number6344844-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: