Healthcare Provider Details

I. General information

NPI: 1609310275
Provider Name (Legal Business Name): DR. ANDREA CAMPBELL WEATHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 08/18/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAKEMED CHILDREN'S PM URGENT CARE 8841 SIX FORKS ROAD, SUITE 102
RALEIGH NC
27615
US

IV. Provider business mailing address

105 SCOTTINGHAM LN
MORRISVILLE NC
27560-7568
US

V. Phone/Fax

Practice location:
  • Phone: 984-217-5437
  • Fax: 984-205-1626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39709
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: