Healthcare Provider Details

I. General information

NPI: 1720502057
Provider Name (Legal Business Name): CANDACE HOUSTON DEYERLING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST FL 16
INDIANAPOLIS IN
46204-1904
US

IV. Provider business mailing address

201 N ILLINOIS ST 16TH FLOOR-SOUTH TOWER
INDIANAPOLIS IN
46204-1904
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704380953
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010998A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0993200
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: