MEDICARE: MS. JULIE LYNNE SLAVIK PA

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	363AS0400X	Surgical Physician Assistant	PA404	AR

General Provider Information

NPI Number	:	1962452938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE LYNNE SLAVIK PA

Provider Business Mailing Address
First Line	:	1000 S 52ND ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8610
Country	:	US
Telephone Number	:	479-271-9607
Fax Number	:	479-281-2133

Provider Business Practice Location Address
First Line	:	1000 S 52ND ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8610
Country	:	US
Telephone Number	:	479-271-9607
Fax Number	:	479-281-2133

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/21/2022

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