Healthcare Provider Details

I. General information

NPI: 1184941015
Provider Name (Legal Business Name): MICHELLE WEAVER, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E CENTRAL ST
WARREN AR
71671-3405
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR SUITE 200
LITTLE ROCK AR
72211-4316
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-7216
  • Fax:
Mailing address:
  • Phone: 501-812-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE-5904
License Number StateAR

VIII. Authorized Official

Name: MICHELLE WEAVER
Title or Position: OWNER
Credential: MD
Phone: 501-812-7216