Provider Demographics
NPI:1487876975
Name:WEST, JAN WINSOME (MSN, PMHCNS/NP-BC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:WINSOME
Last Name:WEST
Suffix:
Gender:F
Credentials:MSN, PMHCNS/NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 TILLEY FARM RD
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-9309
Mailing Address - Country:US
Mailing Address - Phone:919-451-6645
Mailing Address - Fax:
Practice Address - Street 1:1805 TILLEY FARM RD
Practice Address - Street 2:
Practice Address - City:ROUGEMONT
Practice Address - State:NC
Practice Address - Zip Code:27572-9309
Practice Address - Country:US
Practice Address - Phone:919-451-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105380163W00000X, 364SP0809X
NC138163W00000X
NC5004710363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113093Medicaid