Provider Demographics
NPI:1548691934
Name:TIFFANY WEATHERS
Entity type:Organization
Organization Name:TIFFANY WEATHERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBGYN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-790-4905
Mailing Address - Street 1:5204 VILLAGE PKWY
Mailing Address - Street 2:SUITE #11
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8104
Mailing Address - Country:US
Mailing Address - Phone:479-790-4905
Mailing Address - Fax:
Practice Address - Street 1:5204 VILLAGE PKWY
Practice Address - Street 2:SUITE #11
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8104
Practice Address - Country:US
Practice Address - Phone:479-790-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42194282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital