Individual
KRISTINE A WEAVER-MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
811 AINSWORTH DR STE 109, PRESCOTT, AZ 86301
(928) 771-5595
(928) 771-5596
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5987
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4309
AZ
363AM0700X
Medical Physician Assistant
3135
CO
363AS0400X
Surgical Physician Assistant
5179956-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021673
KAISER COMMERCIAL NUMBER
CO
05
—
79221513
—
CO
05
—
813847
—
AZ
05
—
D0968
—
UT
Enumeration date
05/27/2006
Last updated
11/05/2019
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