Provider Demographics
NPI:1669022414
Name:WEAKNECHT, JODI ALLISON (PA-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ALLISON
Last Name:WEAKNECHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 CHRISTMAN RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9243
Mailing Address - Country:US
Mailing Address - Phone:484-256-0301
Mailing Address - Fax:
Practice Address - Street 1:3465 NAZARETH RD STE 102
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8359
Practice Address - Country:US
Practice Address - Phone:610-330-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060852363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical