Provider Demographics
NPI:1447758362
Name:WEAVER, ALEXANDRIA MARY (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 891625
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-1625
Mailing Address - Country:US
Mailing Address - Phone:405-735-9348
Mailing Address - Fax:405-703-3116
Practice Address - Street 1:2921 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6332
Practice Address - Country:US
Practice Address - Phone:405-757-7818
Practice Address - Fax:405-703-0645
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106472163WP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics