Provider Demographics
NPI:1134393929
Name:WEST, KELLY LEIGH (MD, PHD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:WEST
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 NEW GARDEN ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2567
Mailing Address - Country:US
Mailing Address - Phone:336-609-6240
Mailing Address - Fax:
Practice Address - Street 1:2006 NEW GARDEN ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2567
Practice Address - Country:US
Practice Address - Phone:336-609-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00163207ZD0900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program