Provider Demographics
NPI:1992152144
Name:WEAVER, KRYSTAL ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:ELIZABETH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2036
Mailing Address - Country:US
Mailing Address - Phone:423-839-1600
Mailing Address - Fax:423-839-1602
Practice Address - Street 1:231 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2036
Practice Address - Country:US
Practice Address - Phone:423-839-1600
Practice Address - Fax:423-839-1602
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA3043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant