Healthcare Provider Details

I. General information

NPI: 1447174321
Provider Name (Legal Business Name): CANDACE GREEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 107
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 107
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-2303
  • Fax:
Mailing address:
  • Phone: 614-371-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: