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Licensing details for: A 192405

Name: SHIFFLETT, KENDALL ANNE

License Type: Physician and Surgeon A

Primary Status: Renewal Pending - Licensee failed to certify compliance with the continuing medical education requirement and/or failed to certify that he or she disclosed the names of those health-related facilities in which the licensee and/or family may have a financial interest. Practice is permitted unless license expires.

School Name: Geisinger Commonwealth School of Medicine

Graduation Year: 2020

Previous Names: Shifflett, Kendall Anne

Address of Record

2480 Sonoma St
REDDING CA 96001-3027
SHASTA county
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Issuance Date

December 21, 2023

Expiration Date

March 1, 2026

Current Date / Time

April 3, 2026
11:38:36 AM

Public Record Actions

Public Documents

License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: SHIFFLETT, KENDALL ANNE

License/Registration Type: Postgraduate Training License

License Number: 5510 Primary Status: License Canceled

Address :
350 E Del Mar Blvd Apt 112
PASADENA CA 91101-2749
LOS ANGELES COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

Current Training Status
Postgraduate Training
Postgraduate Training Years
2
Primary Area of Practice
Family Medicine
Secondary Area of Practice
Not Applicable
ABMS Certifications
Other - None
Are you retired?
No
Practice Activities
Direct Patient Care (including telehealth) - 40+ Hours
Percentage (%) of patient care hours spent on telehealth - 0
Training - 1-9 Hours
Research - None
Administration - None
Other - None
Primary Practice Location
Zip - 96001
United States Primary Practice Location
Secondary Practice Location
Not Applicable
Are you Hispanic, Latino/a, or of Spanish origin?
No
Race
White/Caucasian
Language Fluency
English
Gender Identity
Female

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