Kelly Egan Weaver, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0110005235 Issued in VA

Practice address

1201 Broad Rock Blvd Richmond VA 23224
Richmond, VA 23249-4915

Phone

(804) 675-5000

NPI assigned

Mar 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458691200000",
    "number": "1477915098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 BROAD ROCK BLVD RICHMOND VA 23224",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232494915",
            "telephone_number": "804-675-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 BROAD ROCK BLVD RICHMOND VA 23224",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232494915",
            "telephone_number": "804-675-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "KELLY",
        "middle_name": "EGAN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-23",
        "last_updated": "2016-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110005235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Lynn Kostric Weatherford, PHARMD
• Gail McLoda Weatherford, FNP
• Shakeba S Weathers, NP
• John Arthur Weaver, M. D.
• Kadra Weaver, PSYD
• Yvonne Jackson Weaver, M.D.
• Jennie Webb-Wright, M.D.
• Charles Nathan Webb, MD
• Frances McMahon Webb
• Laura Libuit Webb, M.D.

• Surgical Physician Assistant in Richmond, VA
• Providers in Richmond, VA by specialty
• Surgical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.