Healthcare Provider Details

I. General information

NPI: 1861851081
Provider Name (Legal Business Name): JASON SLAYDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 WINDMILL LN
LAKE CHARLES LA
70605-0535
US

IV. Provider business mailing address

7013 WINDMILL LN
LAKE CHARLES LA
70605-0535
US

V. Phone/Fax

Practice location:
  • Phone: 337-370-1493
  • Fax:
Mailing address:
  • Phone: 337-370-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP08928
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN130632
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR095327
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: