MEDICARE: MS. KELLY ANN WEAVER RN, MSN, FNP, ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	413453	NY
2	363LF0000X	Family Nurse Practitioner	F330977	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821115015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY ANN WEAVER RN, MSN, FNP, ARNP-C

Provider Business Mailing Address
First Line	:	2151 S ALT A1A STE 425
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-4070
Country	:	US
Telephone Number	:	561-979-2001
Fax Number	:	561-462-0852

Provider Business Practice Location Address
First Line	:	2151 S ALT A1A STE 425
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33477-4070
Country	:	US
Telephone Number	:	561-979-2001
Fax Number	:	561-462-0852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/13/2024

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Directions to “ MS. KELLY ANN WEAVER RN, MSN, FNP, ARNP-C” Practice Location

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