1801957691 NPI number — MRS. KRISTIE LEANNE SLUDER LCAS

Table of content: DR. NASSIM KHATAIE DDS (NPI 1699117200)

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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