Provider Demographics
NPI:1407053648
Name:WEIR, SHARON DARLENE
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DARLENE
Last Name:WEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39906 E 219TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-9279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39906 E 219TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64061-9279
Practice Address - Country:US
Practice Address - Phone:816-865-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6448-9631305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization