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NPI Code Detail

MEDICARE: MRS. CANDICE MICHELLE MCGOWAN FNP-BC

MEDICARE: MRS. CANDICE MICHELLE MCGOWAN 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
1363LF0000XFamily Nurse Practitioner2004008683MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12004008683OTHERMONURSE PRACTITIONER LICENSURE

General Provider Information

NPI Number : 1639403876
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CANDICE MICHELLE MCGOWAN FNP-BC
Provider Business Mailing Address
First Line : PO BOX 616788
Second Line :
City : ORLANDO
State : FL
Zip : 32861-6788
Country : US
Telephone Number : 407-447-7120
Fax Number : 407-770-0661
Provider Business Practice Location Address
First Line : 19401 E 39TH ST S
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64057-2308
Country : US
Telephone Number : 816-490-4277
Fax Number : 855-446-7160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2009
Last Update Date : 11/29/2021

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