Individual
JEANETTE KAY WEICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
855 MONTGOMERY, FORT WORTH, TX 76107-2553
(817) 735-3627
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00655
TX
363AM0700X
Medical Physician Assistant
PA00655
TX
364SF0001X
Family Health Clinical Nurse Specialist
00655
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307767901
—
TX
05
—
307767902
—
TX
01
—
897N31
BCBS
TX
01
—
899N18
BCBS
TX
Enumeration date
02/20/2008
Last updated
10/17/2013
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