Provider Demographics
NPI:1134457252
Name:SLOCUM, AMANDA BATES (MSN, NP - C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BATES
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:MSN, NP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-355-4593
Mailing Address - Fax:
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR FL 3
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2963
Practice Address - Country:US
Practice Address - Phone:704-355-4593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC195409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1596Medicaid
NC1134457252Medicaid
NCNCV658AMedicare PIN
SCNP1596Medicaid