Provider Demographics
NPI:1245491448
Name:WEST-WILSON, KERSTIN INGER (RNC, IBCLC)
Entity type:Individual
Prefix:
First Name:KERSTIN
Middle Name:INGER
Last Name:WEST-WILSON
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 W TWIN OAKS ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1453
Mailing Address - Country:US
Mailing Address - Phone:918-494-6455
Mailing Address - Fax:918-494-7390
Practice Address - Street 1:2409 W TWIN OAKS ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1453
Practice Address - Country:US
Practice Address - Phone:918-494-6455
Practice Address - Fax:918-494-7390
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK197-14363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK197-14363OtherIBCLC