Provider Demographics
NPI:1316546047
Name:YOUNG, CANDICE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N LILLY DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:WV
Mailing Address - Zip Code:24935-7418
Mailing Address - Country:US
Mailing Address - Phone:304-207-1616
Mailing Address - Fax:
Practice Address - Street 1:200 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6444
Practice Address - Country:US
Practice Address - Phone:304-255-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV79041163W00000X
WV107082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse