Provider Demographics
NPI:1235763079
Name:WEBER, KANDI M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:M
Last Name:WEBER
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 1:421 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-2202
Mailing Address - Country:US
Mailing Address - Phone:812-547-0475
Mailing Address - Fax:812-547-1300
Practice Address - Street 1:421 7TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2202
Practice Address - Country:US
Practice Address - Phone:812-547-0475
Practice Address - Fax:812-547-1300
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009866A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71009866AOtherSTATE LICENSE