Provider Demographics
NPI:1164156675
Name:WEST, KYMBERLY JANE (RN)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:JANE
Last Name:WEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11767 JACKSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:16350-4513
Mailing Address - Country:US
Mailing Address - Phone:814-706-1766
Mailing Address - Fax:
Practice Address - Street 1:11767 JACKSON RUN RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:PA
Practice Address - Zip Code:16350-4513
Practice Address - Country:US
Practice Address - Phone:814-706-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY651560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse