MEDICARE: ADAMA WEATHERSPOON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	132958	AR

General Provider Information

NPI Number	:	1396347522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAMA WEATHERSPOON APRN

Provider Business Mailing Address
First Line	:	7307 WESTWIND DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-9505
Country	:	US
Telephone Number	:	501-658-4209
Fax Number	:

Provider Business Practice Location Address
First Line	:	7307 WESTWIND DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-9505
Country	:	US
Telephone Number	:	501-658-4209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	04/07/2026

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