Weaver Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

R629189 Issued in MS

Legal business name

WEAVER CLINIC, LLC

Practice address

124 W Commerce St
Hernando, MS 38632-2240

Phone

(901) 262-0185

NPI assigned

Aug 19, 2014

Organization subpart

No

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

Authorized official

Name

Beverly Pounders Weaver, FNP

Title

Medical Supervisor

Phone

(901) 262-0185

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417392000000",
    "number": "1366841066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 W COMMERCE ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322240",
            "telephone_number": "901-262-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W COMMERCE ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322240",
            "telephone_number": "901-262-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEAVER CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2014-12-01",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "POUNDERS",
        "authorized_official_title_or_position": "MEDICAL SUPERVISOR",
        "authorized_official_telephone_number": "901-262-0185",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "R629189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122952",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kristen Nicole Walls, OT
• Jenevieve Lynn Wardell, LPC-S
• Malinda Renee Watson, SLP
• Callissa L. Wells
• Sherika Lashea Wheeler, PHARMD
• Hannah Elizabeth White, LCSW
• James O White, M.D.
• Tarsha Whitehead

• Clinic/Center in Hernando, MS
• Providers in Hernando, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; 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.