Provider Demographics
NPI:1396485223
Name:WEST, CHARLES E
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 COLUMBIA ROAD 18
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AR
Mailing Address - Zip Code:71861-9721
Mailing Address - Country:US
Mailing Address - Phone:318-578-3605
Mailing Address - Fax:
Practice Address - Street 1:1220 COLUMBIA ROAD 18
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AR
Practice Address - Zip Code:71861-9721
Practice Address - Country:US
Practice Address - Phone:318-578-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty