MEDICARE: JASON SLAYDON

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	367500000X	Certified Registered Nurse Anesthetist	AP08928	LA
2	163W00000X	Registered Nurse	RN130632	LA
3	163W00000X	Registered Nurse	R095327	AR

General Provider Information

NPI Number	:	1861851081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SLAYDON

Provider Business Mailing Address
First Line	:	7013 WINDMILL LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0535
Country	:	US
Telephone Number	:	337-370-1493
Fax Number	:

Provider Business Practice Location Address
First Line	:	7013 WINDMILL LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0535
Country	:	US
Telephone Number	:	337-370-1493
Fax Number	:

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	05/09/2017

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