Healthcare Provider Details

I. General information

NPI: 1053972109
Provider Name (Legal Business Name): ALEXIS WEAVER APRN-CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 E LIVINGSTON AVE
COLUMBUS OH
43205-2838
US

IV. Provider business mailing address

528 CRESTVIEW RD
COLUMBUS OH
43202-2243
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-0660
  • Fax:
Mailing address:
  • Phone: 937-750-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number446830
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number025037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: