Kathleen Marie Slack, RN, MSN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

197713 Issued in MA

Practice address

155 South Street
Ste 101
Wrentham, MA 02093-2838

Phone

(508) 964-3330

NPI assigned

Mar 9, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrative Psychiatry & Wellness Co.

  • Psychiatric/Mental Health Nurse Practitioner
  • Wrentham, MA
  • NPI 1427738624
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1346997343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 BARTON RD",
            "city": "FOXBOROUGH",
            "state": "MA",
            "postal_code": "020352838",
            "telephone_number": "508-596-6720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 SOUTH STREET",
            "address_2": "STE 101",
            "city": "WRENTHAM",
            "state": "MA",
            "postal_code": "020932838",
            "telephone_number": "508-964-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "credential": "RN, MSN, PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-09",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "197713",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "197713",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylan Shaw, LPN
• Shi-III Wrentham LLC
• Shriver Clinical Services
• Sein H. Siao, DMD
• Stephen Signes, RPH
• Andre Eugene St Germain, DMD MSCD
• Elisabeth Steiner Smith
• Sukhi Dental PC
• Melissa J Teixeira, R.N.
• The Piller Group

• Psychiatric/Mental Health Nurse Practitioner in Wrentham, MA
• Providers in Wrentham, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.