MEDICARE: KASEY JOLEE WEAVER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	F344622-01	NY
2	363LF0000X	Family Nurse Practitioner	344622	NY
3	163W00000X	Registered Nurse	702580	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306403449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY JOLEE WEAVER FNP

Provider Business Mailing Address
First Line	:	550 ORCHARD PARK RD STE A110
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-650-5720
Fax Number	:	716-650-4618

Provider Business Practice Location Address
First Line	:	550 ORCHARD PARK RD STE A110
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2646
Country	:	US
Telephone Number	:	716-650-5720
Fax Number	:	716-650-4618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	03/04/2026

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Directions to “ KASEY JOLEE WEAVER FNP” Practice Location

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