Provider Demographics
NPI:1346916657
Name:WEATHERBY, DAREN CLATE (PA-C)
Entity Type:Individual
Prefix:
First Name:DAREN
Middle Name:CLATE
Last Name:WEATHERBY
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18511 HIGHLANDER MEDICS STREET
Mailing Address - Street 2:
Mailing Address - City:FT. BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:915-569-3213
Mailing Address - Fax:
Practice Address - Street 1:18511 HIGHLANDER MEDICS STREET
Practice Address - Street 2:
Practice Address - City:FT. BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-569-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant