1801957691 NPI number — MRS. KRISTIE LEANNE SLUDER LCAS

Table of content: MRS. KRISTIE LEANNE SLUDER LCAS (NPI 1801957691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801957691 NPI number — MRS. KRISTIE LEANNE SLUDER LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLUDER
Provider First Name:
KRISTIE
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCAS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLUDER
Provider Other First Name:
KRISTIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCAS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801957691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 BLACKBERRY INN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEAVERVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28787-9754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-649-9999
Provider Business Mailing Address Fax Number:
828-575-5316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 BLACKBERRY INN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEAVERVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28787-9754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-333-3609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

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: 101YA0400X , with the licence number:  2148 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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