Provider Demographics
NPI:1174615454
Name:WEAVER FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:WEAVER FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E J
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:615-874-3422
Mailing Address - Street 1:4962 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-4126
Mailing Address - Country:US
Mailing Address - Phone:615-874-3422
Mailing Address - Fax:615-874-3465
Practice Address - Street 1:4962 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-4126
Practice Address - Country:US
Practice Address - Phone:615-874-3422
Practice Address - Fax:615-874-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726846Medicare ID - Type UnspecifiedGROUP #