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General NPI Number Information
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NPI Number | 1669184420
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Entity Type | Individual
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Provider Name | KIMBERLY MARIE WEST FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 2040 DAN PROCTOR DR STE 120
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City | SAINT MARYS
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State | GA
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Zip | 31558-3812
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Country | US
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Telephone | 912-576-6434
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Fax | 912-576-6487
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Provider Business Mailing Address
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Address Line | 2040 DAN PROCTOR DR STE 120
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City | SAINT MARYS
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State | GA
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Zip | 31558-3812
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Country | US
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Telephone | 912-576-6434
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Fax | 912-576-6487
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN129312
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License Number State | GA
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