Provider Demographics
NPI:1497907554
Name:HICKEL, CANDACE D (PA-C)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:D
Last Name:HICKEL
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 1:3831 PIPER ST
Mailing Address - Street 2:SUITE S450
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-258-6999
Mailing Address - Fax:907-258-9470
Practice Address - Street 1:3831 PIPER ST
Practice Address - Street 2:SUITE S450
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-258-6999
Practice Address - Fax:907-258-9470
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1995363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1995OtherSTATE LICENSE
AK1570498Medicaid