Kristi M Slack, CF NP
Individual provider Active NPI Nurse Practitioner · Marietta, MS
NPI 1003840232 · NPPES record last updated Apr 11, 2008
Key facts
- NPI
- 1003840232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R853095 (MS)
- Practice address
- 3 County Road 4050
Marietta, MS 38856 - Phone
- (662) 728-2408
- Fax
- (662) 728-2409
- NPI assigned
- Jul 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- North Mississippi Medical Center, Inc.
Practice addresses (Care Compare)
738 S Gloster St
Suite B
Tupelo, MS 38801-4932
Phone (662) 377-3896
Hospital & facility affiliations
- North Mississippi Medical Center
- North Mississippi Medical Center-Gilmore Amory
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040831001284 | MS | Practitioner - Nurse Practitioner | 3375518582 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R853095 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Mississippi Medcial Center, Inc. | Current |
Accepting new patients | |
| North Mississippi Medical Center | Current | Accepting new patients | |
| North Mississippi Medical Center, Inc. | Current |
Accepting new patients | |
| North Mississippi Medical Center Inc | Current | Accepting new patients | |
| Amory Surgery Clinic, PLLC | Past | Accepting new patients | |
| Tupelo Anesthesia Group PA | Past | Accepting new patients |
Locations
830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136
738 S Gloster St
Ste B
Tupelo, MS 38801
Phone (662) 377-3896
Interoperability endpoints
- kristislack@nmhs.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R853095 | MS | Yes |
Addresses
Primary practice location
3 County Road 4050
Marietta, MS 38856
Mailing address
PO Box 56
Marietta, MS 38856-0056
Phone (662) 728-2408
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00239247 | Medicaid | MS |
Other providers in Marietta, MS
All providers in Marietta, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.