Provider Demographics
NPI:1861851081
Name:SLAYDON, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SLAYDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7013 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0535
Mailing Address - Country:US
Mailing Address - Phone:337-370-1493
Mailing Address - Fax:
Practice Address - Street 1:7013 WINDMILL LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-0535
Practice Address - Country:US
Practice Address - Phone:337-370-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08928367500000X
LARN130632163W00000X
ARR095327163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse