DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: KELLY RAE WEAVER CPNP-PC

MEDICARE: KELLY RAE WEAVER CPNP-PC
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
1363LP0200XPediatric Nurse Practitioner226455LA

General Provider Information

NPI Number : 1881318756
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RAE WEAVER CPNP-PC
Provider Business Mailing Address
First Line : 1444 SUWANNEE LN
Second Line :
City : BENTON
State : LA
Zip : 71006-8805
Country : US
Telephone Number : 318-272-3208
Fax Number :
Provider Business Practice Location Address
First Line : 1 SAINT MARY PL
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4307
Country : US
Telephone Number : 318-272-3208
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 10/04/2022

Similar Medicare Providers

1427990183 — DR. ANNE MARIE OGDEN DO
Practice Location Address:
1 SAINT MARY PL
SHREVEPORT, LA
71101-4307
Practice Phone: 318-626-4300
Practice Fax:
1508522558 — OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC
Practice Location Address:
1 SAINT MARY PL
SHREVEPORT, LA
71101-4307
Practice Phone: 318-626-4300
Practice Fax:
1295479681 — HANNAH HANSEN
Practice Location Address:
1 SAINT MARY PL
SHREVEPORT, LA
71101-4307
Practice Phone: 318-626-4300
Practice Fax:
1558113662 — LAYNE ALLEN LANDRY MD
Practice Location Address:
1 SAINT MARY PL
SHREVEPORT, LA
71101-4307
Practice Phone: 318-675-5379
Practice Fax: 318-675-4671
1811880776 — JIMMIE L. JONES III MD
Practice Location Address:
1 SAINT MARY PL
SHREVEPORT, LA
71101-4307
Practice Phone: 318-626-4300
Practice Fax:
1053252031 — COURTNEY TRAHAN LEBLANC RN, CPN
Practice Location Address:
1 SAINT MARY PL
SHREVEPORT, LA
71101-4307
Practice Phone: 337-654-3075
Practice Fax:

Directions to “ KELLY RAE WEAVER CPNP-PC” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.