Angela Slater, LPN-230804

Key facts

NPI

1750103222

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

230804 (MS)

Practice address

1935 Lakeland Dr Ste 900
Jackson, MS 39216-5028

Phone

(601) 718-2468

Fax

(601) 718-2487

NPI assigned

Oct 28, 2024

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

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.

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  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 28, 2024.

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1750103222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 LAKELAND DR STE 900",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165028",
            "telephone_number": "601-718-2468",
            "fax_number": "601-718-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 LAKELAND DR STE 900",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165028",
            "telephone_number": "601-718-2468",
            "fax_number": "601-718-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLATER",
        "first_name": "ANGELA",
        "credential": "LPN-230804",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "230804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

• Jennifer Carolyn Skinner, LCSW
• Lauren Skinner
• Craig Stanley Skousen, MD
• Megan Egbert Slade, F.N.P.
• Angela Slater, AGNP, C
• Marquise Slator
• Charles L Slaughter, PT
• Audie Caroline Hayman Slay, MD
• William Tanner Slay
• Catherine Carter Sledge, D.M.D.

All providers in Jackson, MS · Licensed Practical Nurse in Mississippi