Provider Demographics
NPI:1497538268
Name:WEST, SHELBY JORDAN (EMT-P)
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:JORDAN
Last Name:WEST
Suffix:
Gender:F
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 E MURDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3633
Mailing Address - Country:US
Mailing Address - Phone:316-570-4125
Mailing Address - Fax:
Practice Address - Street 1:402 N TOPEKA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2414
Practice Address - Country:US
Practice Address - Phone:316-570-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSM5079431146L00000X
KS59334146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic