Individual
PATTI SUZANNE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-4065
(601) 703-3050
Mailing address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R731838
MS
363LA2200X
Adult Health Nurse Practitioner
R731838
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124944
—
MS
01
—
500024670
RAILROAD MEDICARE
—
05
—
891003790
—
AL
Enumeration date
11/17/2005
Last updated
11/08/2013
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