Healthcare Provider Details

I. General information

NPI: 1477217438
Provider Name (Legal Business Name): SANDRA KAYLIE SLAUGHTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E APPLEBY RD STE 401
FAYETTEVILLE AR
72703-3163
US

IV. Provider business mailing address

3264 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4005
US

V. Phone/Fax

Practice location:
  • Phone: 479-404-2500
  • Fax: 479-404-2501
Mailing address:
  • Phone: 479-521-3300
  • Fax: 479-521-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number217878
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: