Provider Demographics
NPI:1821248659
Name:WEED, KATE LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:LAUREN
Last Name:WEED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:LAUREN
Other - Last Name:BRATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1714 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5427
Mailing Address - Country:US
Mailing Address - Phone:850-877-4134
Mailing Address - Fax:850-402-9130
Practice Address - Street 1:1714 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5427
Practice Address - Country:US
Practice Address - Phone:850-877-4134
Practice Address - Fax:850-402-9130
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104795363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP475ZOtherMEDICARE
FLY06TBOtherBLUE CROSS BLUE SHIELD OF FLORIDA