Healthcare Provider Details

I. General information

NPI: 1659559201
Provider Name (Legal Business Name): CANDACE ELIZABETH KISER B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MACK ALFORD CORRECTIONAL CENTER
STRINGTOWN OK
74569
US

IV. Provider business mailing address

PO BOX 220
STRINGTOWN OK
74569-0220
US

V. Phone/Fax

Practice location:
  • Phone: 580-346-7301
  • Fax: 580-346-7214
Mailing address:
  • Phone: 580-346-7301
  • Fax: 580-346-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: