Provider Demographics
NPI:1205581568
Name:WEBER, JADE CHRISTIAN
Entity type:Individual
Prefix:MRS
First Name:JADE
Middle Name:CHRISTIAN
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:CHRISTIAN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5348 S COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37184
Mailing Address - Country:US
Mailing Address - Phone:270-577-3523
Mailing Address - Fax:
Practice Address - Street 1:1535 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3315
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician