Provider Demographics
NPI:1750148813
Name:WEEKLEY, TIFFANIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:WEEKLEY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18911 CC HWY
Mailing Address - Street 2:
Mailing Address - City:BLACKWATER
Mailing Address - State:MO
Mailing Address - Zip Code:65322-2258
Mailing Address - Country:US
Mailing Address - Phone:660-621-3022
Mailing Address - Fax:
Practice Address - Street 1:2716 FORUM BLVD STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5450
Practice Address - Country:US
Practice Address - Phone:573-447-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-42324163WL0100X
MO2008004537163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant