Healthcare Provider Details

I. General information

NPI: 1457044257
Provider Name (Legal Business Name): KIERA RU'SHELLE SLADE FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8838 CLAYTON BLVD STE 700
CLAYTON NC
27520-4843
US

IV. Provider business mailing address

3801 BARRETT DR
RALEIGH NC
27609-7224
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-8409
  • Fax: 877-622-8953
Mailing address:
  • Phone: 919-870-8409
  • Fax: 877-622-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018168
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05231126
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: