Provider Demographics
NPI:1063188837
Name:WEWER, WHITNEY D
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:D
Last Name:WEWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 N MOUNTAIN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-7847
Mailing Address - Country:US
Mailing Address - Phone:479-997-5023
Mailing Address - Fax:
Practice Address - Street 1:1109 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-3363
Practice Address - Country:US
Practice Address - Phone:479-474-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1886074201Medicaid