Provider Demographics
NPI:1326818303
Name:WEST, SARAH BETH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CREAL SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:62922-1216
Mailing Address - Country:US
Mailing Address - Phone:618-771-7037
Mailing Address - Fax:
Practice Address - Street 1:711 E KASKASKIA ST
Practice Address - Street 2:
Practice Address - City:MENARD
Practice Address - State:IL
Practice Address - Zip Code:62259
Practice Address - Country:US
Practice Address - Phone:618-826-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028462363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health