Provider Demographics
NPI:1437282670
Name:DELAND, CANDACE WALKER (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:WALKER
Last Name:DELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5135 DIXIE HWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1771
Mailing Address - Country:US
Mailing Address - Phone:502-938-5236
Mailing Address - Fax:502-709-4722
Practice Address - Street 1:5135 DIXIE HWY
Practice Address - Street 2:SUITE 12
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1771
Practice Address - Country:US
Practice Address - Phone:502-938-5236
Practice Address - Fax:502-709-4722
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY206032084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry