Provider Demographics
NPI:1467641043
Name:WEAVER, JANNA WYATT (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:WYATT
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 FENCELINE DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1269
Mailing Address - Country:US
Mailing Address - Phone:940-367-7367
Mailing Address - Fax:
Practice Address - Street 1:721 FENCELINE DR
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-1269
Practice Address - Country:US
Practice Address - Phone:940-367-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1201X
TXDT80611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management