Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 3016453 | KY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3016453 | KY |
NPI | 1013676949 |
---|---|
Provider Name | Chassidy Weatherford |
First Address | Chicago, IL 60677-6347 |
Second Address | Louisville, KY 40241-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2021 |
Last Update Date | 28/01/2022 |