Individual provider Active NPI

Kaitlyn Wathen West, DO

  • Pediatrics Physician
  • Owensboro, KY
National Provider Identifier
1205413309
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
05717 Issued in KY
Practice address
1000 Breckenridge St Ste 300
Owensboro, KY 42303
Phone
(270) 688-4480
Fax
(270) 688-4489
NPI assigned
Mar 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 05717 KY Primary

Addresses

Primary practice location

1000 Breckenridge St Ste 300
Owensboro, KY 42303

Mailing address

PO Box 23229
Owensboro, KY 42304-3229
Phone (270) 688-1330

Other practice location 1

571 S Floyd St Ste 412
Louisville, KY 40202-3877
Phone (502) 629-8828

Other names 1

  • Kaitlyn Elizabeth Wathen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241219002802 KY Practitioner - Pediatric Medicine 3274060926 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
05717KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Owensboro Health Medical Group Inc Current Accepting new patients
Owensboro Health Medical Group, Inc Pediatrics CurrentSince Oct 11, 2024 Accepting new patients
Owensboro Health Medical Group Inc CurrentSince Oct 11, 2024 Accepting new patients
Owensboro Health Inc Past Accepting new patients
Owensboro Health Medical Group, Inc Pediatrics Past Accepting new patients

Locations

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

1201 Pleasant Valley Rd
Owensboro, KY 42303
Phone (270) 417-2000

2211 Mayfair Dr
Ste 102
Owensboro, KY 42301
Phone (270) 688-1351

1000 Breckenridge St
Ste 300
Owensboro, KY 42303
Phone (270) 688-4480

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1205413309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330",
            "fax_number": "270-688-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BRECKENRIDGE ST STE 300",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "42303",
            "telephone_number": "270-688-4480",
            "fax_number": "270-688-4489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "571 S Floyd St Ste 412",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402023877",
            "country_code": "US",
            "telephone_number": "502-629-8828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEST",
        "first_name": "KAITLYN",
        "middle_name": "WATHEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "05717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "WATHEN",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Owensboro, KY

Sources for this page

Verify at the official NPI Registry.