Provider Demographics
NPI:1598043457
Name:ELLERBEE, CANDACE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:ELLERBEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:E
Other - Last Name:YEARGAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6915 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1822
Mailing Address - Country:US
Mailing Address - Phone:210-341-1487
Mailing Address - Fax:210-341-0442
Practice Address - Street 1:16811 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3404
Practice Address - Country:US
Practice Address - Phone:360-735-8100
Practice Address - Fax:360-253-1781
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671071163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671071OtherREGISTERED NURSE