Provider Demographics
NPI:1417469958
Name:WEAVER, REBEKAH C (NP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:C
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:C
Other - Last Name:RAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2 LONGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4518
Mailing Address - Country:US
Mailing Address - Phone:423-557-3153
Mailing Address - Fax:
Practice Address - Street 1:2 LONGVIEW LN
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4518
Practice Address - Country:US
Practice Address - Phone:423-557-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23344363LF0000X
TN198508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse