Provider Demographics
NPI:1659483907
Name:WEST, KERRY L (NP)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:L
Last Name:WEST
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-4704
Mailing Address - Country:US
Mailing Address - Phone:318-473-1964
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HIGHWAY
Practice Address - Street 2:VA MEDICAL
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71306-9004
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN68676APO4120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C428OtherMEDICARE-PTAN
LA1143715Medicaid
LA4C428OtherMEDICARE-PTAN