Healthcare Provider Details

I. General information

NPI: 1669016044
Provider Name (Legal Business Name): SARA CHILDRESS WEAVER AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MAIN ST STE 1100
DANVILLE VA
24541-2938
US

IV. Provider business mailing address

1008 JOHNSON RD
DRY FORK VA
24549-4107
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-3009
  • Fax: 434-791-3228
Mailing address:
  • Phone: 434-724-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024178101
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: