Individual provider · Type 1 NPI

Kelly Rae Weaver, CPNP-PC

Pediatric Nurse Practitioner · Shreveport, LA

NPI number 1881318756 Active

Practice location

1 Saint Mary Pl
Shreveport, LA 71101-4307

Mailing address

1444 Suwannee Ln
Benton, LA 71006-8805

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200X226455 (LA)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1881318756

Kelly Rae Weaver, CPNP-PC's National Provider Identifier is 1881318756, issued on Oct 3, 2022. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Shreveport, LA. The record was last updated on Oct 4, 2022.