Provider Demographics
NPI:1417708231
Name:WEAVER, AMANDA SHEPHERD (AGNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHEPHERD
Last Name:WEAVER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6200
Mailing Address - Country:US
Mailing Address - Phone:828-713-2784
Mailing Address - Fax:
Practice Address - Street 1:193 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2731
Practice Address - Country:US
Practice Address - Phone:828-586-8935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner