Provider Demographics
NPI:1114580271
Name:WEAVER, KATELYN JOY (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:JOY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:JOY
Other - Last Name:KOSTREVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2373 G RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1002
Mailing Address - Country:US
Mailing Address - Phone:970-263-2680
Mailing Address - Fax:
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1002
Practice Address - Country:US
Practice Address - Phone:970-263-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COF03190591363LF0000X
COAPN.0994622-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily