Nicholas Weaver, PA
Individual provider Active NPI Medical Physician Assistant · Amity, AR
NPI 1487944286 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1487944286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA433 (AR)
- Practice address
- 329 N Hill St
Amity, AR 71921-9635 - Phone
- (870) 342-5606
- Fax
- (870) 334-2580
- NPI assigned
- Apr 13, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140604000490 | AR | Practitioner - Physician Assistant | 2163673781 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA433 | AR | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA433 | AR | Yes |
Addresses
Primary practice location
329 N Hill St
Amity, AR 71921-9635
Mailing address
329 N Hill St
Amity, AR 71921-9635
Phone (870) 342-5606
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA433 | Other | AR | LICENSES NUMBER |
Other providers in Amity, AR
- Kim G. Rogers
- Michael Jai Singh
- Samantha Noel Snow
- Tiffany White Counseling, PLLC
- United Methodist Behavioral Health Systems, Inc
- Shawna M White
- Tiffany Elizabeth White
All providers in Amity, AR · Medical Physician Assistant in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.