Individual
MR. KENNETH LEON WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5220 NORTHSHORE DR, NORTH LITTLE ROCK, AR 72118-5297
(501) 663-6455
(501) 663-4877
Mailing address
5220 NORTHSHORE DR, NORTH LITTLE ROCK, AR 72118-5297
(501) 663-6455
(501) 663-4877
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA214
AR
363AS0400X
Surgical Physician Assistant
PA214
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199358795
—
AR
Enumeration date
04/17/2006
Last updated
04/01/2025
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