Provider Demographics
NPI:1619444627
Name:SLAYTON, KIMBERLY ELLEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-686-5510
Mailing Address - Fax:573-872-4671
Practice Address - Street 1:2725 N WESTWOOD BLVD STE 5
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2367
Practice Address - Country:US
Practice Address - Phone:573-872-4671
Practice Address - Fax:573-872-4675
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018026396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily