Provider Demographics
NPI:1164422648
Name:WEISS-KAFFIE, CYNTHIA JO (APRN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JO
Last Name:WEISS-KAFFIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2607
Mailing Address - Country:US
Mailing Address - Phone:806-766-0310
Mailing Address - Fax:806-744-9580
Practice Address - Street 1:1602 10TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2607
Practice Address - Country:US
Practice Address - Phone:806-766-0310
Practice Address - Fax:806-744-9580
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX512515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17208801Medicaid