Provider Demographics
NPI:1386885986
Name:MERRIWEATHER, KEITH L (MHPP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:L
Last Name:MERRIWEATHER
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6478
Mailing Address - Country:US
Mailing Address - Phone:501-624-7111
Mailing Address - Fax:501-620-5109
Practice Address - Street 1:1615 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-2233
Practice Address - Country:US
Practice Address - Phone:501-332-5236
Practice Address - Fax:501-332-8535
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician