Kendra Renee Weaver, PSY.D.

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

P0000002474 Issued in TN

Practice address

James H. Quillen/Vamc
Corner of Sidney and Lamont (Johnson City)
Mountain Home, TN 37684

Phone

(423) 926-1171

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1154355717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 MARK DR",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376153856",
            "telephone_number": "423-926-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "JAMES H. QUILLEN/VAMC",
            "address_2": "CORNER OF SIDNEY AND LAMONT (JOHNSON CITY)",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "37684",
            "telephone_number": "423-926-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "KENDRA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "TN",
            "license": "P0000002474",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P0000002474",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy N Wagner, OTR/L
• Mary Ann Walser, RRT
• Paulette Susan Walton, MSOT
• Anna Rose Warm
• Bryan Lee Watson, D.O.
• Karen Lucille Welch, FNP
• Kimberly Welch, PHARMD
• Amanda Lynn Wellens, PHARMD
• Alysa C Werkheiser-Quillen, APRN
• Kelly Whaley, LMSW

• Addiction (Substance Use Disorder) Psychologist in Mountain Home, TN
• Providers in Mountain Home, TN by specialty
• Addiction (Substance Use Disorder) Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.