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General NPI Number Information
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NPI Number | 1407445059
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Entity Type | Individual
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Provider Name | CANDACE MARTINA HACK APRN
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Gender | Female
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 11 MCLEOD LN
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City | MADISONVILLE
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State | KY
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Zip | 42431-3650
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Country | US
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Telephone | 270-245-2413
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Fax | 877-302-0536
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Provider Business Mailing Address
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Address Line | 11 MCLEOD LN
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City | MADISONVILLE
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State | KY
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Zip | 42431-3650
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Country | US
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Telephone | 270-245-2413
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Fax | 877-302-0636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3015668
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License Number State | KY
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