Provider Demographics
NPI:1972593200
Name:SLAUGHTER, CONNIE RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:RAE
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2268
Mailing Address - Country:US
Mailing Address - Phone:661-323-9090
Mailing Address - Fax:661-323-7999
Practice Address - Street 1:820 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2283
Practice Address - Country:US
Practice Address - Phone:661-323-9090
Practice Address - Fax:661-323-7999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS84878Medicare UPIN