Jennifer P. Weakland, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10645070-4405 Issued in UT

Practice address

1200 E 3900 S
Salt Lake City, UT 84124

Phone

(801) 268-7111

NPI assigned

Dec 9, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mountainstar Behavioral Health LLC

  • Neurology Physician
  • Bountiful, UT
  • NPI 1174868525
  Medicare reassignment NPD
• St Mark'S Professional Services, LLC

  • Internal Medicine Physician
  • Salt Lake City, UT
  • NPI 1912925629
  Medicare reassignment
• Catholic Health Initiatives Colorado

  • Orthopaedic Surgery Physician
  • Longmont, CO
  • NPI 1891675294
  NPD (past)
• Kraus Behavioral Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Windsor Mill, MD
  • NPI 1215472923
  NPD (past)
• Pikaart Enterprises, Inc

  • Gynecologic Oncology Physician
  • Monument, CO
  • NPI 1164775292
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1083859714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742353",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 3900 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84124",
            "telephone_number": "801-268-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "90 Ritchie Hwy",
            "address_2": "Hospice of the Chesapeake",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "MD",
            "postal_code": "211224303",
            "country_code": "US",
            "telephone_number": "410-987-2003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEAKLAND",
        "first_name": "JENNIFER",
        "middle_name": "P.",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "AC000882",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024167173",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC000882",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "AC000882",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "10645070-4405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055157100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "8525916",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "9068913",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD",
            "identifier": "976869-02",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "316970",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC",
            "identifier": "258254",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST DC",
            "identifier": "X697-0008",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rustie Chastina Wayne-Jones
• Lauren Wayne
• Seth S Wayne, ATC
• WB Eyecare LLC
• Amy Gallop Weagley, MD
• Tobyn Wayne Weakley, BSN, RN
• Melissa Lynn Weakly
• Benjamin Wear, RBT
• Serena Danielle Weatherhead
• Eloise Weathersby

• Family Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.