Provider Demographics
NPI:1508466228
Name:SLAYDEN, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SLAYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 COUNTY ROAD 148
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-4409
Mailing Address - Country:US
Mailing Address - Phone:361-894-3227
Mailing Address - Fax:
Practice Address - Street 1:582 COUNTY ROAD 148
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-4409
Practice Address - Country:US
Practice Address - Phone:361-894-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191149164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse