Healthcare Provider Details

I. General information

NPI: 1316491319
Provider Name (Legal Business Name): EMORY SLATER LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 BUFFALO RD
MOUNTAIN HOME AR
72653-7691
US

IV. Provider business mailing address

4675 BUFFALO RD
MOUNTAIN HOME AR
72653-7691
US

V. Phone/Fax

Practice location:
  • Phone: 870-321-6691
  • Fax:
Mailing address:
  • Phone: 870-321-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number012016
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: