Healthcare Provider Details

I. General information

NPI: 1609330810
Provider Name (Legal Business Name): CANDACE L ADKINS RN, AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W I 20 STE 120
ARLINGTON TX
76017-5871
US

IV. Provider business mailing address

811 W I 20 STE 120
ARLINGTON TX
76017-5871
US

V. Phone/Fax

Practice location:
  • Phone: 817-468-3393
  • Fax: 817-468-8734
Mailing address:
  • Phone: 817-468-3393
  • Fax: 817-468-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number727722
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number727722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: