KELLY WEAVER (NPI# 1437764214) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437764214 |
| Entity Type | Individual |
| Full Name | KELLY WEAVER |
| Credential | CPNP-PC |
| Practice Address |
11315 Pembroke Square 110 Waldorf MD 20603 |
| Mailing Address |
3554 Promenade Pl Apt 210 Waldorf MD 20603-7227 |
| Practice Telephone | 3018937061 |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
R245041 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | MARYLAND BOARD OF NURSING | R245041 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 23000 Moakley St, Leonardtown, MD 206502915 | 3014757222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235657552 | Kelly Anne Weaver | Nurse Practitioner | 1012 N Mills Ave, Arcadia, FL 34266-8811 | 2017-09-07 |
| 1477915098 | Kelly Egan Weaver | Physician Assistant | 1201 Broad Rock Blvd Richmond Va 23224, Richmond, VA 23249-4915 | 2016-03-23 |
| 1295101384 | Kelly Weaver | Physical Therapist | 892 Oak Knoll Dr, Perrysburg, OH 43551-2910 | 2015-08-12 |
| 1316232234 | Kelly Weaver | Speech-Language Pathologist | 709 Goodrich Ct, Platteville, CO 80651-7586 | 2011-06-20 |
| 1164713186 | Kelly M Weaver | Licensed Practical Nurse | 17915 Wildcat Rd, Danville, OH 43014-9560 | 2011-04-25 |
| 1821115015 | Kelly Ann Weaver | Registered Nurse | 13660 Jog Road Suite 2, Delray Beach, FL 33446-3806 | 2007-03-23 |
| 1275575334 | Kelly M Weaver | Psychologist | 3011 Bethel Rd Ste 100, Columbus, OH 43220-6104 | 2006-06-12 |
| 1528684750 | Kelly Weaver | Pharmacist | 125 Hall Rd, Seagoville, TX 75159-2915 | 2020-06-23 |
| 1609429695 | Kelly L Weaver | Behavior Technician | 41521 W 11 Mile Rd, Novi, MI 48375-1803 | 2019-07-19 |
| 1316440381 | Kelly Brook Weaver | Nurse Practitioner | 315 Martin Luther King Jr Way, Tacoma, WA 98405-4234 | 2018-03-15 |
| Street Address |
11315 PEMBROKE SQUARE 110 |
| City | WALDORF |
| State | MD |
| Zip Code | 20603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| 1710147608 | Greater Metropolitan Orthopaedics | Physical Therapist | 11325 Pembrooke Square, Suite 115, Waldorf, MD 20603 | 2008-06-13 |
| Find all providers in zip 20603 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851946305 | Monica Patel | Nurse Practitioner | 3450 Old Washington Rd Ste 100, Waldorf, MD 20602-3249 | 2019-08-01 |
| 1225552219 | Erin Sobek | Nurse Practitioner | 11315 Pembrooke Sq Ste 110, Waldorf, MD 20603-4806 | 2017-08-01 |
| 1164812145 | Sarah Kimball | Nurse Practitioner | 3500 Old Washington Rd, Suite 101, Waldorf, MD 20602-3224 | 2015-01-29 |
| 1356776678 | Alita-geri Kiana Smith | Nurse Practitioner | 6 Post Office Rd, Ste. 102, Waldorf, MD 20602-2746 | 2013-09-05 |
| 1750421392 | Cynthia Landrum-tsu | Nurse Practitioner | 3500 Old Washington Rd, Suite 101, Waldorf, MD 20602-3224 | 2007-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902405574 | Kylie White | Nurse Practitioner | 29595 Millstream Dr, Salisbury, MD 21804-2006 | 2020-10-23 |
| 1003420282 | Mary Claire Perry | Nurse Practitioner | 737 W Lombard St Ste 314, Baltimore, MD 21201-1009 | 2020-09-03 |
| 1063022853 | Lauren Ranieri | Nurse Practitioner | 5301 Westbard Cir Ste 3, Bethesda, MD 20816-1463 | 2020-08-06 |
| 1841847209 | Brittany Nichole Frankel | Nurse Practitioner | 5870 Old Washington Rd, Sykesville, MD 21784-8622 | 2019-08-21 |
| 1912553595 | Kelsey Lynn Peifer | Nurse Practitioner | 6131 Baldridge Ter, Frederick, MD 21701-5858 | 2019-08-10 |
| 1841845351 | Advanced Practice Wellness, LLC | Nurse Practitioner | Washingtonian Blvd Ste 550, Gaithersburg, MD 20878 | 2019-08-02 |
| 1922651082 | Deborah A Weber | Nurse Practitioner | 480 Lake Dr, Lusby, MD 20657-3260 | 2019-07-18 |
| 1700438140 | Emily Megan Burke | Nurse Practitioner | 200 Forbes St Annapolis, Md 21401, Suite 200, Annapolis, MD 21401 | 2019-07-16 |
| 1699234393 | Stacey Lyn Williams | Nurse Practitioner | 1122 Gypsy Ln W, Towson, MD 21286-1404 | 2019-03-13 |
| 1386110666 | Caroline Van Voorhis | Nurse Practitioner | 18310 Montgomery Village Ave Ste 460, Gaithersburg, MD 20879-3565 | 2018-10-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.