Healthcare Provider Details

I. General information

NPI: 1447938949
Provider Name (Legal Business Name): CANDACE MICHELLE KOCKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E INNOVATION WAY
AKRON OH
44316-0001
US

IV. Provider business mailing address

1760 HAMPTON KNOLL DR
AKRON OH
44313-9161
US

V. Phone/Fax

Practice location:
  • Phone: 501-286-9797
  • Fax:
Mailing address:
  • Phone: 501-286-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number222025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: