Provider Demographics
NPI:1114448768
Name:WEAVER, AMBER SINCLAIRE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SINCLAIRE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 HITE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9398
Mailing Address - Country:US
Mailing Address - Phone:304-476-8497
Mailing Address - Fax:772-238-2080
Practice Address - Street 1:1044 HITE CIR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9398
Practice Address - Country:US
Practice Address - Phone:304-476-8497
Practice Address - Fax:772-238-2080
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN57284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1114448768Medicaid
WV1295341253Medicaid