Provider Demographics
NPI:1780121863
Name:WEAVER, JORDAN K (CRNP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:K
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:256-705-4224
Mailing Address - Fax:256-705-4135
Practice Address - Street 1:101 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-1207
Practice Address - Country:US
Practice Address - Phone:256-760-0422
Practice Address - Fax:256-284-6065
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1326373861OtherGROUP NPI