Healthcare Provider Details

I. General information

NPI: 1568125201
Provider Name (Legal Business Name): CANDACE LYNNE LAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MAIN ST
HULBERT OK
74441-8902
US

IV. Provider business mailing address

PO BOX 751
HULBERT OK
74441-0751
US

V. Phone/Fax

Practice location:
  • Phone: 918-772-1233
  • Fax: 918-772-1233
Mailing address:
  • Phone: 918-772-3390
  • Fax: 918-772-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219040
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number207058
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: