Provider Demographics
NPI:1689932410
Name:WEAVER, MELINDA (MHPP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP
Mailing Address - Street 1:1309 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72823-3230
Mailing Address - Country:US
Mailing Address - Phone:479-641-0730
Mailing Address - Fax:479-641-0732
Practice Address - Street 1:1309 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:AR
Practice Address - Zip Code:72823-3230
Practice Address - Country:US
Practice Address - Phone:479-641-0730
Practice Address - Fax:479-641-0732
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator