Provider Demographics
NPI:1760434609
Name:SLATER, JENNIFER KAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:SLATER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WINKLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:917 REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4210
Mailing Address - Country:US
Mailing Address - Phone:217-205-3376
Mailing Address - Fax:217-481-7020
Practice Address - Street 1:917 REMINGTON RD
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4210
Practice Address - Country:US
Practice Address - Phone:217-205-3376
Practice Address - Fax:217-481-7020
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2281363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
U7355AOtherMEDICARE PTAN