Provider Demographics
NPI:1902540537
Name:WEST, KEIRSTAN (NP)
Entity Type:Individual
Prefix:
First Name:KEIRSTAN
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8802
Mailing Address - Fax:
Practice Address - Street 1:4829 N STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-9620
Practice Address - Country:US
Practice Address - Phone:765-489-3935
Practice Address - Fax:765-489-6344
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28225249A163WE0003X
IN71013012A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency