Provider Demographics
NPI:1376972000
Name:WEATHERSBY, NAKEISHA NICOLE (CNM, APN)
Entity Type:Individual
Prefix:MRS
First Name:NAKEISHA
Middle Name:NICOLE
Last Name:WEATHERSBY
Suffix:
Gender:F
Credentials:CNM, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7729 S THROOP ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3756
Mailing Address - Country:US
Mailing Address - Phone:773-991-5757
Mailing Address - Fax:
Practice Address - Street 1:800 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:773-702-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010565363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology