Individual
RICKEY GENE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 HIGHLINE DR, E WENATCHEE, WA 98802-5341
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003164
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8446148
—
WA
01
—
8493WE
REGENCE BLUE SHIELD
WA
Enumeration date
07/12/2006
Last updated
06/20/2019
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