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General NPI Number Information
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NPI Number | 1952947533
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Entity Type | Individual
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Provider Name | CANDACE RENAE VINSON
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 3377 ROUTE 60 E
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City | HUNTINGTON
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State | WV
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Zip | 25705
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Country | US
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Telephone | 304-399-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 BLUE LICK RD
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City | WINFIELD
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State | WV
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Zip | 25213-7713
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Country | US
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Telephone | 304-881-3649
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Fax |
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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 | 104264
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License Number State | WV
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