Provider Demographics
NPI:1962645101
Name:WEAVER, KIMBERLY RENEE (IDMT, NREMT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:IDMT, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 ABS/SG
Mailing Address - Street 2:UNIT 6585
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09643-6585
Mailing Address - Country:US
Mailing Address - Phone:314-722-8069
Mailing Address - Fax:
Practice Address - Street 1:CTRA SEVILLE MORON KM 48
Practice Address - Street 2:
Practice Address - City:MORON AIR BASE
Practice Address - State:SEVILLA
Practice Address - Zip Code:41530
Practice Address - Country:ES
Practice Address - Phone:314-722-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic