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General NPI Number Information
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NPI Number | 1225237423
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Entity Type | Organization
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Legal Business Name | WEST MCCRACKEN HEALTHCARE PLLC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 5325 METROPOLIS LAKE RD
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City | WEST PADUCAH
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State | KY
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Zip | 42086-9474
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Country | US
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Telephone | 270-488-3141
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Fax | 270-488-2137
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Provider Business Mailing Address
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Address Line | 5325 METROPOLIS LAKE RD
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City | WEST PADUCAH
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State | KY
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Zip | 42086-9474
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Country | US
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Telephone | 270-488-3141
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Fax | 270-488-2137
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL S RUST
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Credential | DNP
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Telephone | 270-488-3141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3156P
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License Number State | KY
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