MEDICARE: CANDACE NEWBOLD FNP-BC

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	363LP2300X	Primary Care Nurse Practitioner	10024447	OR
2	363LF0000X	Family Nurse Practitioner	10591236-4405	UT

General Provider Information

NPI Number	:	1346001633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE NEWBOLD FNP-BC

Provider Business Mailing Address
First Line	:	2821 DAGGETT AVE STE 200
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-274-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 DAGGETT AVE STE 200
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-274-8400
Fax Number	:

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	04/08/2026

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Directions to “ CANDACE NEWBOLD FNP-BC” Practice Location

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