Provider Demographics
NPI:1790346484
Name:WEST, MITCHELL W (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:W
Last Name:WEST
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1876
Mailing Address - Country:US
Mailing Address - Phone:859-238-7746
Mailing Address - Fax:859-236-0261
Practice Address - Street 1:236 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1876
Practice Address - Country:US
Practice Address - Phone:859-238-7746
Practice Address - Fax:859-236-0261
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant