Provider Demographics
NPI:1285904250
Name:WEATHERSPOON, ZAKIYYAH V (FNP-BC; PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ZAKIYYAH
Middle Name:V
Last Name:WEATHERSPOON
Suffix:
Gender:
Credentials:FNP-BC; PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W CRANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2930
Mailing Address - Country:US
Mailing Address - Phone:229-244-1400
Mailing Address - Fax:229-244-5512
Practice Address - Street 1:105 W CRANFORD AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2930
Practice Address - Country:US
Practice Address - Phone:229-247-7350
Practice Address - Fax:229-468-0042
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177186363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003196084AMedicaid