Healthcare Provider Details

I. General information

NPI: 1144955568
Provider Name (Legal Business Name): REMINGTON WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 S 14TH AVE
OZARK MO
65721-8890
US

IV. Provider business mailing address

PO BOX 11619
CONWAY AR
72034-0028
US

V. Phone/Fax

Practice location:
  • Phone: 940-390-8088
  • Fax:
Mailing address:
  • Phone: 501-327-6665
  • Fax: 501-730-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018040097
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number144388
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: