Individual
BLAKE D. WEATHERBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2710 S RIFE MEDICAL LN, ROGERS, AR 72758-1452
(479) 338-8000
(479) 338-3056
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(479) 338-8000
(479) 338-3056
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
864477
TX
163W00000X
Registered Nurse
TEMP213551
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
213551
AR
Other
Enumeration date
12/03/2020
Last updated
02/01/2021
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