Provider Demographics
NPI:1629734934
Name:WEATHERS, ASHLEY N (CFNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEST CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64863-9417
Mailing Address - Country:US
Mailing Address - Phone:417-762-3287
Mailing Address - Fax:417-762-3255
Practice Address - Street 1:109 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEST CITY
Practice Address - State:MO
Practice Address - Zip Code:64863-9417
Practice Address - Country:US
Practice Address - Phone:417-762-3287
Practice Address - Fax:417-762-3255
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021038566363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO436809082OtherFEIN