MEDICARE: JESSICA WEAVER

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	390200000X	Student in an Organized Health Care Education/Training Program	0001299269	VA

General Provider Information

NPI Number	:	1467309716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WEAVER

Provider Business Mailing Address
First Line	:	701 HORNSWOOD CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-7760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 THUNDER RD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7704
Country	:	US
Telephone Number	:	252-549-2887
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ JESSICA WEAVER ” Practice Location

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