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General NPI Number Information
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NPI Number | 1255745998
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Entity Type | Individual
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Provider Name | SAMANTHA WEST
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Gender | Female
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 707 N EMPORIA ST
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City | WICHITA
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State | KS
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Zip | 67214-3707
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Country | US
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Telephone | 316-858-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 124 RYAN AVE
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City | DANVILLE
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State | KS
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Zip | 67036-8739
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Country | US
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Telephone | 620-243-3280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 24-00640
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License Number State | KS
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