Provider Demographics
NPI:1750094116
Name:WEAVER, KATHRYN COOK (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COOK
Last Name:WEAVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 E BROW RD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3321
Mailing Address - Country:US
Mailing Address - Phone:508-942-1047
Mailing Address - Fax:
Practice Address - Street 1:2515 DESALES AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1100
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily