Provider Demographics
NPI:1538253505
Name:SLYCORD, JOSEPHINE A (FNP)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:A
Last Name:SLYCORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E TICKLE ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3120
Mailing Address - Country:US
Mailing Address - Phone:731-285-2410
Mailing Address - Fax:731-287-2177
Practice Address - Street 1:400 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3120
Practice Address - Country:US
Practice Address - Phone:731-285-2410
Practice Address - Fax:731-287-2177
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68742163W00000X
TN6020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341971Medicaid
TN3341971Medicare PIN
TN103I503359Medicare PIN
TNR85817Medicare UPIN
TNP00348458Medicare PIN