Provider Demographics
NPI:1912391608
Name:WEIGARTZ, KATHERINE YVONNE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:YVONNE
Last Name:WEIGARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 DICKENS FERRY RD APT 106
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3973
Mailing Address - Country:US
Mailing Address - Phone:256-679-3243
Mailing Address - Fax:
Practice Address - Street 1:6701 DICKENS FERRY RD APT 106
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3973
Practice Address - Country:US
Practice Address - Phone:256-679-3243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10832390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program