Provider Demographics
NPI:1265047484
Name:SLUSHER, JAKOB (FNP-C)
Entity type:Individual
Prefix:
First Name:JAKOB
Middle Name:
Last Name:SLUSHER
Suffix:
Gender:M
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 1:111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-2119
Mailing Address - Country:US
Mailing Address - Phone:601-557-5105
Mailing Address - Fax:601-557-5106
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2119
Practice Address - Country:US
Practice Address - Phone:601-557-5105
Practice Address - Fax:601-557-5106
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty