Individual
KELLY WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8208
(225) 654-4642
Mailing address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A8769
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A8769
LICENSE
LA
Enumeration date
10/14/2015
Last updated
10/14/2015
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