Healthcare Provider Details

I. General information

NPI: 1124938717
Provider Name (Legal Business Name): CANDACE BEAM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 NICHOLSON DR
HUDSON OH
44236-3766
US

IV. Provider business mailing address

5670 NICHOLSON DR
HUDSON OH
44236-3766
US

V. Phone/Fax

Practice location:
  • Phone: 937-546-8365
  • Fax:
Mailing address:
  • Phone: 937-546-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0043013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: