Individual
KRISTI M SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CF NP
Contact information
Practice address
3 COUNTY ROAD 4050, MARIETTA, MS 38856
(662) 728-2408
(662) 728-2409
Mailing address
PO BOX 56, MARIETTA, MS 38856-0056
(662) 728-2408
(662) 728-2409
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R853095
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00239247
—
MS
Enumeration date
07/11/2006
Last updated
04/11/2008
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