Provider Demographics
NPI:1770845331
Name:WEAVER, VALERIE KAY (CRNA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KAY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:KAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNA
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-1127
Practice Address - Fax:816-404-1103
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018196367500000X
KS557083367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO919848903Medicaid