Provider Demographics
NPI:1073500955
Name:SLAUGHTER, JOHN EARL (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EARL
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 OAKWILDE CIR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4496
Mailing Address - Country:US
Mailing Address - Phone:281-412-0900
Mailing Address - Fax:281-317-8990
Practice Address - Street 1:3815 OAKWILDE CIR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4496
Practice Address - Country:US
Practice Address - Phone:281-412-0900
Practice Address - Fax:281-317-8990
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6779111NN0400X, 111NR0200X, 111NX0100X
TX776723363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BL830OtherBCBS
8AR810OtherBCBS
TX8P5800OtherBLUE CROSS BLUE SHIELD
8AR810OtherBCBS
TXU64886Medicare UPIN
TX284214YRQ2Medicare PIN
TX284214YRQ2Medicare PIN