Healthcare Provider Details

I. General information

NPI: 1013883297
Provider Name (Legal Business Name): CANDACE SIPES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TEACO RD
KENNETT MO
63857-3266
US

IV. Provider business mailing address

304 TEACO RD
KENNETT MO
63857-3266
US

V. Phone/Fax

Practice location:
  • Phone: 573-559-3591
  • Fax: 573-658-1876
Mailing address:
  • Phone: 573-559-3591
  • Fax: 573-658-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number235127
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: