Jennifer Austin Slack, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN001303 Issued in NV

Practice address

4032 N Miller Rd
Suite 108
Scottsdale, AZ 85251-4572

Phone

(480) 360-2299

NPI assigned

Aug 7, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifer.slack@39508185645060.direct.elationemr.com

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.

• Pair of Slacks, LLC

  dba Old Town Scottsdale Weight Loss & Wellness

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1750778387
  NPD (past) Authorized official

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1649426826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14780 W MOUNTAIN VIEW BLVD",
            "address_2": "STE 110",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853747280",
            "telephone_number": "623-322-6923",
            "fax_number": "855-420-6361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4032 N MILLER RD",
            "address_2": "SUITE 108",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852514572",
            "telephone_number": "480-360-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "JENNIFER",
        "middle_name": "AUSTIN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-07",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "APN001303",
            "primary": true
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "AZ",
            "license": "AP3104",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649426826",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sky Drug Inc
• Skyreach Behavioral Health LLC
• Skysong Medical, LLC
• Michelle Slabach, CCC-SLP
• Haley Slack, AUD
• Lawrence Edward Slama, M.D.
• Bonnie Slater, LPC
• Darrienne Slater, NMD
• Emily K Slater, DPT
• Caitlin Nicole Slaughter, PA-C

• Family Nurse Practitioner in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.