MEDICARE: TIMBI D WEST APRN

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	363LF0000X	Family Nurse Practitioner	A01064	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508853466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMBI D WEST APRN

Provider Business Mailing Address
First Line	:	1006 E MAIN STREET
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933
Country	:	US
Telephone Number	:	479-965-7702
Fax Number	:	479-965-2180

Provider Business Practice Location Address
First Line	:	1006 E MAIN STREET
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933
Country	:	US
Telephone Number	:	479-965-7702
Fax Number	:	479-965-2180

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	09/29/2016

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