Provider Demographics
NPI:1528244878
Name:WEAVER, KELLY MICHELE (APRN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:UK GILL HEART INSTITUTE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-323-0295
Mailing Address - Fax:859-257-6699
Practice Address - Street 1:740 S LIMESTONE STE L304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0200
Practice Address - Country:US
Practice Address - Phone:859-323-6494
Practice Address - Fax:859-257-2573
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2025-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3004955363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100129780Medicaid
KY000000814911OtherBSBS- BAPTIST HEALTH MADISONVILLE
KY000000814911OtherBSBS- BAPTIST HEALTH MADISONVILLE