Provider Demographics
NPI:1467444679
Name:KEY, CANDICE PUCKETT (FNPC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:PUCKETT
Last Name:KEY
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNPC
Mailing Address - Street 1:5306 NC HIGHWAY 55 STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7812
Mailing Address - Country:US
Mailing Address - Phone:919-457-1517
Mailing Address - Fax:919-363-7697
Practice Address - Street 1:NEWSOME FAMILY PRACTICE
Practice Address - Street 2:304 MOUNTAINVIEW ROAD
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-983-3016
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000668Medicaid
NC7000668Medicaid