Healthcare Provider Details

I. General information

NPI: 1528244878
Provider Name (Legal Business Name): KELLY MICHELE WEAVER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE L304
LEXINGTON KY
40536-0200
US

IV. Provider business mailing address

800 ROSE ST UK GILL HEART INSTITUTE
LEXINGTON KY
40536-0200
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6494
  • Fax: 859-257-2573
Mailing address:
  • Phone: 859-323-0295
  • Fax: 859-257-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3004955
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3004955
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: