MEDICARE: MS. KATHLEEN K SLATER PA-C

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
1	363A00000X	Physician Assistant	606	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	841452397015	OTHER	CA	ROCKY MOUNTAIN HEALTH PLA

General Provider Information

NPI Number	:	1861432460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN K SLATER PA-C

Provider Business Mailing Address
First Line	:	5771 W 71ST AVE
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-3805
Country	:	US
Telephone Number	:	303-434-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 ROSLYN ST UNIT 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3324
Country	:	US
Telephone Number	:	720-848-9076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	01/17/2008

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