Provider Demographics
NPI:1497709786
Name:MCKEEN, CANDICE R (PA-C)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:R
Last Name:MCKEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 STATE RD
Mailing Address - Street 2:MOB II STE. 2210
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2596
Mailing Address - Country:US
Mailing Address - Phone:513-751-4222
Mailing Address - Fax:513-751-4353
Practice Address - Street 1:7502 STATE RD
Practice Address - Street 2:MOB II STE. 2210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2596
Practice Address - Country:US
Practice Address - Phone:513-751-4222
Practice Address - Fax:513-751-4353
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant