Healthcare Provider Details

I. General information

NPI: 1457218976
Provider Name (Legal Business Name): ROBERT KYLE WEAVER APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W IRONWOOD DR
COEUR D ALENE ID
83814-2604
US

IV. Provider business mailing address

PO BOX 46
SANDPOINT ID
83864-0046
US

V. Phone/Fax

Practice location:
  • Phone: 970-457-7973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3381002
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: