Provider Demographics
NPI:1730719683
Name:WEEDEN, ALEXANDRIA MARIE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:MARIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 W 519 UNIT A
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-9502
Mailing Address - Country:US
Mailing Address - Phone:603-660-7852
Mailing Address - Fax:
Practice Address - Street 1:2900 W 519 UNIT A
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-9502
Practice Address - Country:US
Practice Address - Phone:603-660-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator