Healthcare Provider Details

I. General information

NPI: 1518896489
Provider Name (Legal Business Name): CANDANCE H DEVAUL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 YACHT CLUB LN
SAINT SIMONS ISLAND GA
31522-2312
US

IV. Provider business mailing address

67 LIMB LN
LUMBER CITY GA
31549-2634
US

V. Phone/Fax

Practice location:
  • Phone: 912-222-6149
  • Fax:
Mailing address:
  • Phone: 912-253-6344
  • Fax: 912-253-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP167273
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: