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General NPI Number Information
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NPI Number | 1801868989
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Entity Type | Individual
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Provider Name | MARY MELINDA WEAKLEY MD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 350 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403
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Country | US
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Telephone | 812-332-9874
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Fax | 812-335-7604
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Provider Business Mailing Address
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Address Line | 350 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5001
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Country | US
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Telephone | 812-332-9874
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Fax | 812-335-7604
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 01041728A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01041728A
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License Number State | IN
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