Kelly Nicole West, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

612915 Issued in WI

Practice address

1245 Cheyenne Ave
Suite 104
Grafton, WI 53024

Phone

(262) 377-2668

Fax

(262) 377-2680

NPI assigned

Sep 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442966400000",
    "number": "1760582480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 CHEYENNE AVE",
            "address_2": "SUITE 104",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "53024",
            "telephone_number": "262-377-2668",
            "fax_number": "262-377-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 CHEYENNE AVE",
            "address_2": "SUITE 104",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "53024",
            "telephone_number": "262-377-2668",
            "fax_number": "262-377-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEST",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-23",
        "last_updated": "2015-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901018424",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WI",
            "license": "612915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonita J. Wendel, APNP/BC
• Rachel J Werking, OTL/R
• Darren Werner, D.C.
• Anthony Francis Werth Jr., MS
• West Endodontic Group
• Jule N Wetherbee, M.D.
• Tonia T Whalen, CRNA
• Nicole White, NP
• Rebecca L White, PA-C
• Matthew Paul Wichman, M.D.

• Endodontics in Grafton, WI
• Providers in Grafton, WI by specialty
• Endodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.