Healthcare Provider Details

I. General information

NPI: 1992947220
Provider Name (Legal Business Name): CANDRA C MCINTOSH APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 MONTGOMERY RD STE 250
CINCINNATI OH
45249-2395
US

IV. Provider business mailing address

11085 MONTGOMERY RD STE 250
CINCINNATI OH
45249-2395
US

V. Phone/Fax

Practice location:
  • Phone: 513-547-2861
  • Fax:
Mailing address:
  • Phone: 513-547-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number330155
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0034455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: