Provider Demographics
NPI:1396845764
Name:COULTER, CANDAYCE MELEA (NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CANDAYCE
Middle Name:MELEA
Last Name:COULTER
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MOWWAY RD.-REYNOLD'S ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:ATTN: MCUA-QS MS. PRESCOTT
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-6300
Mailing Address - Country:US
Mailing Address - Phone:580-458-2134
Mailing Address - Fax:580-458-2314
Practice Address - Street 1:2601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-2444
Practice Address - Country:US
Practice Address - Phone:580-255-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0026752163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health