Healthcare Provider Details

I. General information

NPI: 1831652007
Provider Name (Legal Business Name): ASHLEY BROOKE SLATON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S LOUIS TITTLE AVE
MANGUM OK
73554-4406
US

IV. Provider business mailing address

114 S LOUIS TITTLE AVE
MANGUM OK
73554-4406
US

V. Phone/Fax

Practice location:
  • Phone: 580-782-3393
  • Fax: 580-782-3395
Mailing address:
  • Phone: 580-782-3393
  • Fax: 580-782-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85979
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: