=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265841159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE MABBITT CNM, WHNP-BC, PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2014
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6553 CALIFORNIA AVE SW STE B
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98136-1896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-659-7299
-----------------------------------------------------
Fax | 206-659-7299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15260 NE 15TH PL APT B
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98007-4592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-256-7609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP61574928
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | AP 60576932
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------