Provider Demographics
NPI:1003403585
Name:WEST, AMANDA KAY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:WEST
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 3RD ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-5046
Mailing Address - Country:US
Mailing Address - Phone:386-983-7206
Mailing Address - Fax:904-431-3557
Practice Address - Street 1:1000 3RD ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5046
Practice Address - Country:US
Practice Address - Phone:386-983-7206
Practice Address - Fax:904-431-3557
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW395176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife