Provider Demographics
NPI:1396177671
Name:WEATHERLEY, ABBIE LEE (APRN, NP-C)
Entity type:Individual
Prefix:MISS
First Name:ABBIE
Middle Name:LEE
Last Name:WEATHERLEY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:LEE
Other - Last Name:BAINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:PO BOX 505411
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 NW R D MIZE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-655-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76003-011363LF0000X
MO2014036571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily