Healthcare Provider Details

I. General information

NPI: 1023432259
Provider Name (Legal Business Name): CANDACE JOY TEMPLETON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/20/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRADFORD WAY STE 500
KINGSTON TN
37763-3126
US

IV. Provider business mailing address

1000 BRADFORD WAY STE 500
KINGSTON TN
37763-3126
US

V. Phone/Fax

Practice location:
  • Phone: 865-285-9588
  • Fax: 865-297-4188
Mailing address:
  • Phone: 865-285-9588
  • Fax: 865-297-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18310
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18310
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: