Provider Demographics
NPI:1669016044
Name:WEAVER, SARA CHILDRESS (AGNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CHILDRESS
Last Name:WEAVER
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:DRY FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24549-4107
Mailing Address - Country:US
Mailing Address - Phone:434-724-7888
Mailing Address - Fax:
Practice Address - Street 1:201 S MAIN ST STE 1100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2938
Practice Address - Country:US
Practice Address - Phone:434-791-3009
Practice Address - Fax:434-791-3228
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178101363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care