Provider Demographics
NPI:1598187866
Name:WEEKLEY, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WEEKLEY
Suffix:
Gender:F
Credentials:
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 933080
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0034
Mailing Address - Country:US
Mailing Address - Phone:740-623-4369
Mailing Address - Fax:
Practice Address - Street 1:311 S 15TH ST STE 101
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1874
Practice Address - Country:US
Practice Address - Phone:740-622-0332
Practice Address - Fax:740-622-0335
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA15462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096109Medicaid