MEDICARE: CANDACE ANN JAMES PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	7983862-3102	UT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	7983862-8900	UT

General Provider Information

NPI Number	:	1831632348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE ANN JAMES PMHNP-BC

Provider Business Mailing Address
First Line	:	98 EAST 500 SOUTH
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332
Country	:	US
Telephone Number	:	435-553-5915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1638 N 200 E
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341
Country	:	US
Telephone Number	:	435-754-7120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	11/09/2022

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