Provider Demographics
NPI:1629237805
Name:WEST, SARAH I (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:I
Last Name:WEST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:I
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4364 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2534
Mailing Address - Country:US
Mailing Address - Phone:662-560-5966
Mailing Address - Fax:662-560-5969
Practice Address - Street 1:4364 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2534
Practice Address - Country:US
Practice Address - Phone:662-560-5966
Practice Address - Fax:662-560-5969
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS83160OtherUPIN
MSS83160Medicare UPIN