Provider Demographics
NPI:1003243494
Name:WEAVER, KATHERINE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-C
Mailing Address - Street 1:260 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2467
Mailing Address - Country:US
Mailing Address - Phone:770-887-1668
Mailing Address - Fax:770-781-9937
Practice Address - Street 1:260 ELM ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2467
Practice Address - Country:US
Practice Address - Phone:770-887-1668
Practice Address - Fax:770-781-9937
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210470363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner