Healthcare Provider Details

I. General information

NPI: 1306752266
Provider Name (Legal Business Name): CANDACE NICOLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S BONNYVIEW RD
REDDING CA
96001-4515
US

IV. Provider business mailing address

2730 S BONNYVIEW RD
REDDING CA
96001-4515
US

V. Phone/Fax

Practice location:
  • Phone: 209-423-1948
  • Fax:
Mailing address:
  • Phone: 209-423-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number5045C0AD68
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: