Basic Information
| Provider Information | |||||||||
| NPI: | 1538253505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLYCORD | ||||||||
| FirstName: | JOSEPHINE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E TICKLE ST | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380243120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312852410 | ||||||||
| FaxNumber: | 7312872177 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 E TICKLE ST | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380243120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312852410 | ||||||||
| FaxNumber: | 7312872177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 01/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 68742 | TN | N | Nursing Service Providers | Registered Nurse | 363L00000X | 6020 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3341971 | 05 | TN | MEDICAID |