Provider Demographics
NPI:1043992530
Name:WEST, KAITLIN MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MICHELE
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MICHELE
Other - Last Name:BEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2403 FAIRVIEW FARM RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8633
Mailing Address - Country:US
Mailing Address - Phone:336-964-1930
Mailing Address - Fax:
Practice Address - Street 1:713 S FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6667
Practice Address - Country:US
Practice Address - Phone:336-625-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13687363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical