Provider Demographics
NPI:1184191462
Name:MAUZEY, KANDACE KAE (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:KAE
Last Name:MAUZEY
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:KANDACE
Other - Middle Name:
Other - Last Name:VANHOOZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-4710
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST UNIT 690
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5706
Practice Address - Country:US
Practice Address - Phone:502-588-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012639363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300021508Medicaid
KY7100574350Medicaid