Healthcare Provider Details

I. General information

NPI: 1629478581
Provider Name (Legal Business Name): CHRISTA SLAGLE APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA HOSKEY APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SIEGEL ST
TAMA IA
52339-2302
US

IV. Provider business mailing address

402 SIEGEL ST
TAMA IA
52339-2302
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-1766
  • Fax: 620-275-4729
Mailing address:
  • Phone: 620-275-1766
  • Fax: 620-275-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76444
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-128673
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number126378
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: