=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548691934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIFFANY WEATHERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2013
-----------------------------------------------------
Last Update Date | 12/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5204 VILLAGE PKWY SUITE #11
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-8104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-790-4905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5204 VILLAGE PKWY SUITE #11
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-8104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-790-4905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OBGYN
-----------------------------------------------------
Name | DR. TIFFANY WEATHERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 479-790-4905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 42194
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------