MEDICARE: CANDICE KILLPACK FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	14268892-4405	UT

General Provider Information

NPI Number	:	1144171489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE KILLPACK FNP-C

Provider Business Mailing Address
First Line	:	367 W WATERCRESS DR
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-5112
Country	:	US
Telephone Number	:	385-248-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	367 W WATERCRESS DR
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-5112
Country	:	US
Telephone Number	:	385-248-8025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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