Provider Demographics
NPI:1821474891
Name:MERRIWEATHER, JEANETTE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MERRIWEATHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 LEE BEARD WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-3414
Mailing Address - Country:US
Mailing Address - Phone:706-828-7468
Mailing Address - Fax:706-724-7566
Practice Address - Street 1:1446 LEE BEARD WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-3414
Practice Address - Country:US
Practice Address - Phone:706-828-7468
Practice Address - Fax:706-724-7566
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN056496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily