Provider Demographics
NPI:1285008367
Name:WEST FAMILY CARE CLINIC PLLC
Entity Type:Organization
Organization Name:WEST FAMILY CARE CLINIC PLLC
Other - Org Name:WEST FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:731-627-3553
Mailing Address - Street 1:108 EAST DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1404
Mailing Address - Country:US
Mailing Address - Phone:731-627-3553
Mailing Address - Fax:
Practice Address - Street 1:100 E HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059-1169
Practice Address - Country:US
Practice Address - Phone:731-627-3553
Practice Address - Fax:731-882-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty