1457898876 NPI number — CHRISTINE RUTHANNE SLACK NP-C

Table of content: CHRISTINE RUTHANNE SLACK NP-C (NPI 1457898876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457898876 NPI number — CHRISTINE RUTHANNE SLACK NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLACK
Provider First Name:
CHRISTINE
Provider Middle Name:
RUTHANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATTERSON
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
RUTHANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457898876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-9495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-963-2100
Provider Business Mailing Address Fax Number:
813-321-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2316 E MEYER BLVD
Provider Second Line Business Practice Location Address:
1 EAST
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-1199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-974-5050
Provider Business Practice Location Address Fax Number:
816-683-7645
Provider Enumeration Date:
01/23/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  2023037602 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 2023037602 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)