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NPI Code Detail

MEDICARE: MR. KENNETH LEON WEAVER PA-C

MEDICARE: MR. KENNETH LEON WEAVER PA-C
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
1363AS0400XSurgical Physician AssistantPA214AR
2363AM0700XMedical Physician AssistantPA214AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578527412
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH LEON WEAVER PA-C
Provider Business Mailing Address
First Line : 5220 NORTHSHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5297
Country : US
Telephone Number : 501-663-6455
Fax Number : 501-663-4877
Provider Business Practice Location Address
First Line : 5220 NORTHSHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5297
Country : US
Telephone Number : 501-663-6455
Fax Number : 501-663-4877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 04/01/2025

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