Basic Information
| Provider Information | |||||||||
| NPI: | 1508853466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | TIMBI | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799657702 | ||||||||
| FaxNumber: | 4799652180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799657702 | ||||||||
| FaxNumber: | 4799652180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A01064 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200045560A | 05 | OK | MEDICAID | 155430758 | 05 | AR | MEDICAID |