Provider Demographics
NPI:1114488269
Name:WEATHERS, KASI (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KASI
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-9557
Mailing Address - Country:US
Mailing Address - Phone:501-259-3720
Mailing Address - Fax:
Practice Address - Street 1:3133 MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-9557
Practice Address - Country:US
Practice Address - Phone:501-259-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203896706Medicaid