Provider Demographics
NPI:1518271121
Name:WEIGT, STEPHANIE J (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:WEIGT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 E SOUTHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 E 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-8937
Practice Address - Country:US
Practice Address - Phone:574-224-1048
Practice Address - Fax:574-406-9116
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003382363L00000X
IN71003382A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000000742888OtherANTHEM
IN201004980Medicaid
IN0000000742888OtherANTHEM