MEDICARE: VERNIE SLATON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	24980	TN
2	363LF0000X	Family Nurse Practitioner	1-090087	AL

General Provider Information

NPI Number	:	1740756675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNIE SLATON

Provider Business Mailing Address
First Line	:	2899 COUNTY ROAD 739
Second Line	:
City	:	HENAGAR
State	:	AL
Zip	:	35978-3849
Country	:	US
Telephone Number	:	256-605-4836
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 GAULT AVE N
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-2531
Country	:	US
Telephone Number	:	256-979-1633
Fax Number	:	256-304-5456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	09/15/2022

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