Healthcare Provider Details

I. General information

NPI: 1144420829
Provider Name (Legal Business Name): CARLA R SLAYDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE SUITE 525
MEMPHIS TN
38104-3519
US

IV. Provider business mailing address

2922 COVINGTON PIKE
MEMPHIS TN
38128-6007
US

V. Phone/Fax

Practice location:
  • Phone: 901-722-0088
  • Fax: 901-722-0082
Mailing address:
  • Phone: 901-722-0088
  • Fax: 901-722-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12161
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: