Weaver, Kenneth

Weaver, Kenneth is an individual health care provider with primary practice located at 1103 E Jackson Blvd Ste 1, Jonesborough TN 37659. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecology, which is considered as his primary health care specialty. Weaver, Kenneth can be contacted via phone (423) 753-4177.

Contact Information

Primary practice address
1103 E Jackson Blvd Ste 1 Jonesborough TN 37659
Fax: (423) 753-8030
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X MD11216 Tennessee

Profile Details

NPI number 1942262167
LBN Legal business name Weaver, Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942262167 NPPES
Tennessee MEDICAID 3166800

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