Healthcare Provider Details

I. General information

NPI: 1053920181
Provider Name (Legal Business Name): CANDICE ANN HAYES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 FAIR MEADOWS LN STE 102
RALEIGH NC
27607-6449
US

IV. Provider business mailing address

4505 FAIR MEADOWS LN STE 102
RALEIGH NC
27607-6449
US

V. Phone/Fax

Practice location:
  • Phone: 919-670-3939
  • Fax:
Mailing address:
  • Phone: 919-670-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: