Provider Demographics
NPI:1609905983
Name:SLATER, JODIA M (FNP)
Entity type:Individual
Prefix:
First Name:JODIA
Middle Name:M
Last Name:SLATER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9550 ROCKY RIVER RD STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9592
Practice Address - Country:US
Practice Address - Phone:704-457-1510
Practice Address - Fax:704-457-1506
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214803363LF0000X
NC0050-02900363LF0000X
NC5002900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609905983Medicaid
SCNP1101Medicaid
NCNCN083BMedicare PIN
NC1609905983Medicaid
NCNCN083EMedicare PIN
NCNCN083CMedicare PIN
NCNCN083DMedicare PIN