Provider Demographics
NPI:1316546740
Name:WEAVER, KRISTEN AVERY (FNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:AVERY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:VA
Mailing Address - Zip Code:22821-9548
Mailing Address - Country:US
Mailing Address - Phone:540-421-8895
Mailing Address - Fax:
Practice Address - Street 1:322 HIGH ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:VA
Practice Address - Zip Code:22821-9548
Practice Address - Country:US
Practice Address - Phone:540-421-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily