Individual
JENNIFER WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
630 W MAPLE ST, FARMINGTON, NM 87401-6113
(505) 609-6349
(505) 599-4679
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2024-0065
NM
363AM0700X
Medical Physician Assistant
0110003901
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110003901
STATE LICENSE NUMBER
VA
01
—
PA2024-0065
NEW MEXICO BOARD OF MEDICINE
NM
Enumeration date
08/07/2012
Last updated
11/12/2024
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