Individual
NICHOLAS WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
329 N HILL ST, AMITY, AR 71921-9635
(870) 342-5606
(870) 334-2580
Mailing address
329 N HILL ST, AMITY, AR 71921-9635
(870) 342-5606
(870) 334-2580
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA433
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA433
LICENSES NUMBER
AR
Enumeration date
04/13/2011
Last updated
03/07/2023
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