Healthcare Provider Details

I. General information

NPI: 1104224294
Provider Name (Legal Business Name): CANDICE MCCOOL APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S KEENE ST
COLUMBIA MO
65201-6603
US

IV. Provider business mailing address

606 INDEPENDENCE ST
COLUMBIA MO
65203-2439
US

V. Phone/Fax

Practice location:
  • Phone: 573-999-2744
  • Fax:
Mailing address:
  • Phone: 573-999-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2015000989
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: