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General NPI Number Information
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NPI Number | 1144115619
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Entity Type | Individual
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Provider Name | TYLER WAYNE WEAVER AU.D., CCC-A
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 116 RIVER OAKS DR STE 120
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7087
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Country | US
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Telephone | 972-745-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 BOVINE DR APT 9106
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City | FORT WORTH
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State | TX
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Zip | 76244-0047
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Country | US
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Telephone | 662-202-8204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 81764
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License Number State | TX
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