KELLY RAE WEAVER

SHREVEPORT, LA
NPI1881318756
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LP0200X Nurse Practitioner, Pediatrics
(Licence: LA  226455)
Enumeration Date2022-10-03
Last Update Date2022-10-04
Business Address
KELLY RAE WEAVER CPNP-PC
1 SAINT MARY PL
SHREVEPORT, LA 71101-4307
Phone number: 318-272-3208
Mailing Address
KELLY RAE WEAVER CPNP-PC
1444 SUWANNEE LN
BENTON, LA 71006-8805
Phone number: 318-272-3208
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