MEDICARE: CANDYCE NICOLE JOHNSON NP

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	363L00000X	Nurse Practitioner	71016377A	IN

General Provider Information

NPI Number	:	1275418345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDYCE NICOLE JOHNSON NP

Provider Business Mailing Address
First Line	:	7825 BANCASTER CIR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5702
Country	:	US
Telephone Number	:	317-737-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 N CAPITOL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1225
Country	:	US
Telephone Number	:	317-644-1404
Fax Number	:

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

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/08/2025

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