Provider Demographics
NPI:1063632503
Name:SLAGLE, JENNIFER VINEZ (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VINEZ
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:VINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:579 GREENWAY RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4809
Mailing Address - Country:US
Mailing Address - Phone:828-262-0100
Mailing Address - Fax:828-264-7592
Practice Address - Street 1:579 GREENWAY RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4809
Practice Address - Country:US
Practice Address - Phone:828-262-0100
Practice Address - Fax:828-264-7592
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81034Medicare UPIN