Healthcare Provider Details

I. General information

NPI: 1831632348
Provider Name (Legal Business Name): CANDACE ANN JAMES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 11/09/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 N 200 E
LOGAN UT
84341
US

IV. Provider business mailing address

98 EAST 500 SOUTH
PROVIDENCE UT
84332
US

V. Phone/Fax

Practice location:
  • Phone: 435-754-7120
  • Fax:
Mailing address:
  • Phone: 435-553-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7983862-8900
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number7983862-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: