Healthcare Provider Details

I. General information

NPI: 1871876128
Provider Name (Legal Business Name): KANDACE JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KANDACE BUSINGER NP

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5189 W 600 N
MCCORDSVILLE IN
46055-9715
US

IV. Provider business mailing address

13639 CREEKRIDGE LN
FISHERS IN
46055-9599
US

V. Phone/Fax

Practice location:
  • Phone: 317-329-7232
  • Fax:
Mailing address:
  • Phone: 317-690-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71007867A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71007867A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: