Provider Demographics
NPI:1750108577
Name:WEST, KEVANA S (RDMT)
Entity type:Individual
Prefix:
First Name:KEVANA
Middle Name:S
Last Name:WEST
Suffix:
Gender:F
Credentials:RDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FORREST PARK RD APT B3-4
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3849
Mailing Address - Country:US
Mailing Address - Phone:615-900-6579
Mailing Address - Fax:
Practice Address - Street 1:1120 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5405
Practice Address - Country:US
Practice Address - Phone:615-582-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2777225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist