Provider Demographics
NPI:1275851024
Name:MCGOWEN, CANDANCE LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CANDANCE
Middle Name:LEE
Last Name:MCGOWEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 STAGE RD
Mailing Address - Street 2:106
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8955
Mailing Address - Country:US
Mailing Address - Phone:901-737-1992
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:7140 STAGE RD
Practice Address - Street 2:106
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-8955
Practice Address - Country:US
Practice Address - Phone:901-737-1992
Practice Address - Fax:901-309-8784
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014899363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G70941Medicare PIN