Provider Demographics
NPI:1134187123
Name:WEAVER, LINDA KAY (LM, CPM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FLOYD ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1048
Mailing Address - Country:US
Mailing Address - Phone:864-585-7921
Mailing Address - Fax:864-583-7201
Practice Address - Street 1:850 FLOYD ROAD EXT
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1048
Practice Address - Country:US
Practice Address - Phone:864-585-7921
Practice Address - Fax:864-583-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLMW029176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLM0013Medicaid