Provider Demographics
NPI:1518279678
Name:WESTBROOK, KIM (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 HARNEY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-3038
Mailing Address - Country:US
Mailing Address - Phone:307-745-8991
Mailing Address - Fax:
Practice Address - Street 1:2710 HARNEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-3038
Practice Address - Country:US
Practice Address - Phone:307-745-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP 6362207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology