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General NPI Number Information
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NPI Number | 1689619124
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Entity Type | Individual
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Provider Name | CARYN KENDRA SLACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 199 TWIN LAKES RD
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City | BRIDGEPORT
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State | CA
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Zip | 93517-8050
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Country | US
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Telephone | 530-495-2100
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Fax | 530-495-2100
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Provider Business Mailing Address
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Address Line | 250 N SEE VEE LN
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City | BISHOP
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State | CA
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Zip | 93514-8130
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Country | US
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Telephone | 760-873-8464
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Fax | 760-503-5452
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C152597
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License Number State | CA
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