Provider Demographics
NPI:1356508717
Name:SLAGLE, KIRSTEN CLARKE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:CLARKE
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ELLEN
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2974
Mailing Address - Country:US
Mailing Address - Phone:804-520-8135
Mailing Address - Fax:804-520-8092
Practice Address - Street 1:400 SOUTHPARK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2974
Practice Address - Country:US
Practice Address - Phone:804-520-8135
Practice Address - Fax:804-520-8092
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167696363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics