Provider Demographics
NPI:1376932830
Name:WEST, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:100 E HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1169
Mailing Address - Country:US
Mailing Address - Phone:731-627-3553
Mailing Address - Fax:731-882-1256
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19597363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care