Provider Demographics
NPI:1225237423
Name:WEST MCCRACKEN HEALTHCARE PLLC
Entity Type:Organization
Organization Name:WEST MCCRACKEN HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:270-488-3141
Mailing Address - Street 1:5325 METROPOLIS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42086-9474
Mailing Address - Country:US
Mailing Address - Phone:270-488-3141
Mailing Address - Fax:270-488-2137
Practice Address - Street 1:5325 METROPOLIS LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42086-9474
Practice Address - Country:US
Practice Address - Phone:270-488-3141
Practice Address - Fax:270-488-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3156P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty