Provider Demographics
NPI:1710443486
Name:WEAVER, KAITLYN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3423
Mailing Address - Country:US
Mailing Address - Phone:662-678-3258
Mailing Address - Fax:
Practice Address - Street 1:2145 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3423
Practice Address - Country:US
Practice Address - Phone:662-678-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001901363L00000X
MS903114363LG0600X
FLAPRN11001901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology