Provider Demographics
NPI:1518467331
Name:WEAVER, DEBORAH KAY (LVN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SKELLY DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-3543
Mailing Address - Country:US
Mailing Address - Phone:940-923-2459
Mailing Address - Fax:
Practice Address - Street 1:303 SKELLY DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-3543
Practice Address - Country:US
Practice Address - Phone:940-923-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100838164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty