Healthcare Provider Details

I. General information

NPI: 1639536105
Provider Name (Legal Business Name): CANDICE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 PINE
WINTHROP AR
71866
US

IV. Provider business mailing address

PO BOX 16
WINTHROP AR
71866-0016
US

V. Phone/Fax

Practice location:
  • Phone: 513-282-5299
  • Fax:
Mailing address:
  • Phone: 513-282-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: