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General NPI Number Information
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NPI Number | 1841534807
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Entity Type | Individual
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Provider Name | CANDICE HENSON NP
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 107 KOONTZ AVE STE 200
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City | CLENDENIN
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State | WV
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Zip | 25045-9581
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Country | US
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Telephone | 304-548-7272
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Fax | 304-548-7149
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Provider Business Mailing Address
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Address Line | 104 ALEX LN
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City | CHARLESTON
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State | WV
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Zip | 25304-2952
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Country | US
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Telephone | 304-734-2020
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Fax | 304-734-2047
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 120141
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License Number State | WV
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