Healthcare Provider Details

I. General information

NPI: 1124342530
Provider Name (Legal Business Name): RICHARD PAUL SLAYTON MHPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E POPLAR ST
PIGGOTT AR
72454
US

IV. Provider business mailing address

615 E MATTHEWS AVE
JONESBORO AR
72401-3145
US

V. Phone/Fax

Practice location:
  • Phone: 870-897-5585
  • Fax:
Mailing address:
  • Phone: 870-930-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number123359
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: