Provider Demographics
NPI:1083220404
Name:WEAVER, RACHEL GUNN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:GUNN
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 1:1720 NICHOLASVILLE RD STE 502
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1487
Mailing Address - Country:US
Mailing Address - Phone:859-277-7129
Mailing Address - Fax:
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 502
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1487
Practice Address - Country:US
Practice Address - Phone:859-277-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC967363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical