Provider Demographics
NPI:1316172794
Name:SLOCUM, RACHEL ANN (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-863-7393
Mailing Address - Fax:228-864-0546
Practice Address - Street 1:4300B W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2568
Practice Address - Country:US
Practice Address - Phone:228-863-7393
Practice Address - Fax:228-864-0546
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR860595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03580821Medicaid
MS03580821Medicaid
302I507366Medicare PIN
302G700865Medicare PIN