Provider Demographics
NPI:1528244878
Name:WEAVER, KELLY MICHELE (ARNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MICHELE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:UK GILL HEART INSTITUTE
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-323-0295
Mailing Address - Fax:859-257-6699
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:UK GILL HEART INSTITUTE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0200
Practice Address - Country:US
Practice Address - Phone:859-323-0295
Practice Address - Fax:859-257-6699
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000814911OtherBSBS- BAPTIST HEALTH MADISONVILLE
KY7100129780Medicaid
KY000000814911OtherBSBS- BAPTIST HEALTH MADISONVILLE