KELLY WEAVER (NPI# 1578884235) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578884235 |
| Entity Type | Individual |
| Full Name | KELLY WEAVER |
| Credential | DDS |
| Practice Address |
310 W Idaho St Blackfoot ID 83221-1710 |
| Mailing Address |
Po Box 248 Blackfoot ID 83221-0248 |
| Practice Telephone | 2087852255 |
| Practice Fax Number | 2087852275 |
| Mailing Telephone | 2087852255 |
| Mailing Fax Number | 2087852275 |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2011-08-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D4298 | ID | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 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 |
| Street Address |
310 W IDAHO ST |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-1710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700894771 | Richard Russell Burt | Dentist | 310 W Idaho St, Blackfoot, ID 83221-0248 | 2006-08-04 |
| 1891871521 | Blackfoot Smiles, P.a. | Dentist | 310 W Idaho St, Blackfoot, ID 83221-1710 | 2006-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548887136 | Bald 1 Sleep Solutions LLC | Dentist | 790 N Meridian St, Blackfoot, ID 83221-4936 | 2020-06-29 |
| 1104038991 | Brent Wilson Harper | Dentist | 694 W. Hwy. 39, Blackfoot, ID 83221 | 2007-05-04 |
| 1194869990 | Charles Gordon Simpson | Dentist | 1180 Parkway Dr, Blackfoot, ID 83221-0869 | 2007-02-16 |
| 1821104910 | Von James Kunz | Dentist | 600 Jensen Grove Drive, Blackfoot, ID 83221 | 2006-08-22 |
| 1053321885 | Riverside Dental PC | Dentist | 1120 Parkway Dr, Blackfoot, ID 83221 | 2006-08-08 |
| 1700894771 | Richard Russell Burt | Dentist | 310 W Idaho St, Blackfoot, ID 83221-0248 | 2006-08-04 |
| 1205208162 | Family Dental of Blackfoot LLC | Dentist | 2407 Teeples Dr, Blackfoot, ID 83221-5877 | 2015-10-30 |
| 1578958252 | Blackfoot Family Dentistry Pllc | Dentist | 380 W Judicial St, Blackfoot, ID 83221-2122 | 2015-03-31 |
| 1831415447 | Paul Lloyd Hansen | Dentist | 625 W Bridge St, Blackfoot, ID 83221-2018 | 2010-04-08 |
| 1588837496 | Damon T. Armstrong D.d.s., P.c | Dentist | 625 W Pacific St, Suite #4, Blackfoot, ID 83221-2034 | 2008-04-11 |
| Find all providers in BLACKFOOT | ||||
Please comment or provide details below to improve the information on KELLY WEAVER.
| 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.