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NPI Code Detail

MEDICARE: MR. NATHAN JOHN SLAUGHTER DAT, ATC, LAT

MEDICARE: MR. NATHAN JOHN SLAUGHTER DAT, ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer7033243-4810UT

General Provider Information

NPI Number : 1295799971
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN JOHN SLAUGHTER DAT, ATC, LAT
Provider Business Mailing Address
First Line : 730 HARDY WAY
Second Line : APT. E
City : MESQUITE
State : NV
Zip : 89027-4338
Country : US
Telephone Number : 702-345-4406
Fax Number :
Provider Business Practice Location Address
First Line : 351 W UNIVERSITY BLVD
Second Line :
City : CEDAR CITY
State : UT
Zip : 84720-2415
Country : US
Telephone Number : 435-586-7823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2006
Last Update Date : 01/16/2020

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