Provider Demographics
NPI:1629301106
Name:SLUDER, VANESSA K (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:K
Last Name:SLUDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:K
Other - Last Name:FARRIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2778 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-9403
Mailing Address - Country:US
Mailing Address - Phone:662-429-4988
Mailing Address - Fax:662-429-4966
Practice Address - Street 1:2778 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-9403
Practice Address - Country:US
Practice Address - Phone:662-429-4988
Practice Address - Fax:662-429-4966
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868378363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS004073558Medicaid