Provider Demographics
NPI:1477859890
Name:WEST, KRISTIN L (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1411 W. CENTRAL PARK AVE
Mailing Address - Street 2:VERA FRENCH COMMUNITY MENTAL HEALTH CENTER
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804
Mailing Address - Country:US
Mailing Address - Phone:563-383-1900
Mailing Address - Fax:563-884-4638
Practice Address - Street 1:1441 W. CENTRRAL PARK AVE
Practice Address - Street 2:VERA FRENCH COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804
Practice Address - Country:US
Practice Address - Phone:563-383-1900
Practice Address - Fax:563-884-4638
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094735163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42-0716337Medicaid