Individual
JAVLYN DICKSON WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
895 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 587-8401
Mailing address
780 S 2075 W, CEDAR CITY, UT 84720-1921
(435) 463-5285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12989329-1206
UT
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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