Provider Demographics
NPI:1518306273
Name:SISK, CANDICE (CRNA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:SISK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:HEMMINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:MOREHAED
Mailing Address - State:KY
Mailing Address - Zip Code:40351-0968
Mailing Address - Country:US
Mailing Address - Phone:866-413-9534
Mailing Address - Fax:260-407-4428
Practice Address - Street 1:222 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-6500
Practice Address - Fax:606-783-6570
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9201876367500000X
KY3016261367500000X
VA0024174917367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGOtherBCBS
FLPENDINGOtherBCBS