Provider Demographics
NPI:1306151022
Name:SLAUGHTER, MICHAEL M (FNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 LARCHMONT DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5230
Mailing Address - Country:US
Mailing Address - Phone:214-558-1104
Mailing Address - Fax:972-216-1535
Practice Address - Street 1:1216 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2108
Practice Address - Country:US
Practice Address - Phone:903-885-2820
Practice Address - Fax:903-885-2989
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0179018OtherDPS
TXF0179018OtherDPS
TXF0179018OtherDPS
TXTXB128187Medicare PIN