Provider Demographics
NPI:1942828678
Name:WEATHERLY, SAMONE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMONE
Middle Name:
Last Name:WEATHERLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 RS COUNTY ROAD 4410
Mailing Address - Street 2:
Mailing Address - City:POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75472-5541
Mailing Address - Country:US
Mailing Address - Phone:903-438-6108
Mailing Address - Fax:
Practice Address - Street 1:106 HODGE ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4321
Practice Address - Country:US
Practice Address - Phone:903-885-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily