Provider Demographics
NPI:1568825354
Name:SLATON, KALA BURGENER (MD)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:BURGENER
Last Name:SLATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KALA
Other - Middle Name:
Other - Last Name:BURGENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4945
Mailing Address - Country:US
Mailing Address - Phone:501-548-6100
Mailing Address - Fax:501-548-6105
Practice Address - Street 1:2300 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4945
Practice Address - Country:US
Practice Address - Phone:501-548-6100
Practice Address - Fax:501-548-6105
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR390200000X
ARE-13138207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program