Individual
LAURYN B SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 MACCORKLE AVE SE STE 205, CHARLESTON, WV 25304-1228
(304) 388-2303
Mailing address
3100 MACCORKLE AVE SE STE 205, CHARLESTON, WV 25304-1228
(304) 388-2303
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3061
WV
Other
Enumeration date
02/13/2021
Last updated
01/12/2026
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