Healthcare Provider Details

I. General information

NPI: 1922586361
Provider Name (Legal Business Name): COREY R WEAVER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 HICKMAN RD STE 101
CLIVE IA
50325-5314
US

IV. Provider business mailing address

9550 HICKMAN RD STE 101
CLIVE IA
50325-5314
US

V. Phone/Fax

Practice location:
  • Phone: 515-758-8300
  • Fax: 515-758-8600
Mailing address:
  • Phone: 515-758-8300
  • Fax: 515-758-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG104242
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: