Provider Demographics
NPI:1992067375
Name:WEST, KELSEY DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:DIANE
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:DIANE
Other - Last Name:WORTHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1664 N VIRGINIA ST # MS -1332
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0001
Mailing Address - Country:US
Mailing Address - Phone:775-682-8175
Mailing Address - Fax:775-327-2009
Practice Address - Street 1:123 17TH ST BRIGHAM BLDG MS 316
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-3050
Practice Address - Country:US
Practice Address - Phone:775-784-1533
Practice Address - Fax:775-784-8075
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205848132Medicaid