Healthcare Provider Details

I. General information

NPI: 1063138436
Provider Name (Legal Business Name): CAROL JO WEYER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 3RD AVE
JASPER IN
47546-3636
US

IV. Provider business mailing address

607 3RD AVE
JASPER IN
47546-3636
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-2233
  • Fax: 812-482-5680
Mailing address:
  • Phone: 812-482-2233
  • Fax: 812-482-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012999A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: