Provider Demographics
NPI:1881067189
Name:SLAUGHTER, KENNY JR (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:KENNY
Middle Name:
Last Name:SLAUGHTER
Suffix:JR
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8877 LAKES AT 610 DR APT 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2574
Mailing Address - Country:US
Mailing Address - Phone:601-630-5607
Mailing Address - Fax:
Practice Address - Street 1:8877 LAKES AT 610 DR
Practice Address - Street 2:APT 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:601-630-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility