MEDICARE: KYMBERLY JANE WEST RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	651560	NY

General Provider Information

NPI Number	:	1164156675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYMBERLY JANE WEST RN

Provider Business Mailing Address
First Line	:	11767 JACKSON RUN RD
Second Line	:
City	:	SUGAR GROVE
State	:	PA
Zip	:	16350-4513
Country	:	US
Telephone Number	:	814-706-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	11767 JACKSON RUN RD
Second Line	:
City	:	SUGAR GROVE
State	:	PA
Zip	:	16350-4513
Country	:	US
Telephone Number	:	814-706-1766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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