Provider Demographics
NPI:1811244593
Name:SLADE, MEGAN EGBERT (FNP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:EGBERT
Last Name:SLADE
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 1:1860 CHADWICK DR
Mailing Address - Street 2:SUITE 256
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3463
Mailing Address - Country:US
Mailing Address - Phone:662-943-8192
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR
Practice Address - Street 2:SUITE 256
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3463
Practice Address - Country:US
Practice Address - Phone:601-375-1394
Practice Address - Fax:601-376-2005
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR879924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily