Healthcare Provider Details

I. General information

NPI: 1669413894
Provider Name (Legal Business Name): VALERIE B WEAVER APRNBC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GIESLER DRIVE
OSCEOLA MO
64776
US

IV. Provider business mailing address

PO BOX 570
OSCEOLA MO
64776-0570
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-8123
  • Fax:
Mailing address:
  • Phone: 417-646-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number52112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: