Provider Demographics
NPI:1508853466
Name:WEST, TIMBI D (APRN)
Entity Type:Individual
Prefix:
First Name:TIMBI
Middle Name:D
Last Name:WEST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933
Mailing Address - Country:US
Mailing Address - Phone:479-965-7702
Mailing Address - Fax:479-965-2180
Practice Address - Street 1:1006 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933
Practice Address - Country:US
Practice Address - Phone:479-965-7702
Practice Address - Fax:479-965-2180
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200045560AMedicaid
AR155430758Medicaid
ARP10770Medicare UPIN
AR5U909Medicare ID - Type Unspecified