MEDICARE: JOHANNA LEIGHANN WEIR PA-C

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	363AM0700X	Medical Physician Assistant	1668	OK

General Provider Information

NPI Number	:	1740499730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA LEIGHANN WEIR PA-C

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	CHELSEA
State	:	OK
Zip	:	74016-0218
Country	:	US
Telephone Number	:	918-333-3136
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SE FRANK PHILLIPS BLVD
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3644
Country	:	US
Telephone Number	:	918-333-3136
Fax Number	:	918-333-3169

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/14/2015

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Directions to “ JOHANNA LEIGHANN WEIR PA-C” Practice Location

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