Provider Demographics
NPI:1891715025
Name:WEAVER, AMY JOHNANNA (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JOHNANNA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WHITEOAK DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7133
Mailing Address - Country:US
Mailing Address - Phone:409-751-4647
Mailing Address - Fax:409-751-4652
Practice Address - Street 1:17376 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-1114
Practice Address - Country:US
Practice Address - Phone:713-466-0197
Practice Address - Fax:713-477-0375
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584684363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9250Medicare ID - Type Unspecified
TXQ72586Medicare UPIN