Healthcare Provider Details

I. General information

NPI: 1366350779
Provider Name (Legal Business Name): VIRGINIA WEIR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6059 ARBURY WAY
OOLTEWAH TN
37363-5001
US

IV. Provider business mailing address

3161 W SUSAN AVE
PAHRUMP NV
89060-2295
US

V. Phone/Fax

Practice location:
  • Phone: 423-238-8880
  • Fax:
Mailing address:
  • Phone: 775-209-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: