Provider Demographics
NPI:1043873375
Name:WEAVER, MACEY ELIZABETH (DNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MACEY
Middle Name:ELIZABETH
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MISS
Other - First Name:MACEY
Other - Middle Name:ELIZABETH
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:2393 NEW GLASGOW RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-8433
Mailing Address - Country:US
Mailing Address - Phone:615-879-0128
Mailing Address - Fax:
Practice Address - Street 1:2393 NEW GLASGOW RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-8433
Practice Address - Country:US
Practice Address - Phone:615-879-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty