Provider Demographics
NPI:1699580217
Name:WEIKLE, CODY SHANE
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:SHANE
Last Name:WEIKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 CHILDERS RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:WV
Mailing Address - Zip Code:24925
Mailing Address - Country:US
Mailing Address - Phone:304-661-1630
Mailing Address - Fax:
Practice Address - Street 1:1079 CHILDERS RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:WV
Practice Address - Zip Code:24925
Practice Address - Country:US
Practice Address - Phone:304-661-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant