Provider Demographics
NPI:1598716730
Name:BREEDEN, CANDICE R (PA)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:R
Last Name:BREEDEN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1701 RENAISSANCE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3084
Mailing Address - Country:US
Mailing Address - Phone:405-844-4978
Mailing Address - Fax:405-844-0562
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9322
Practice Address - Country:US
Practice Address - Phone:405-748-3300
Practice Address - Fax:877-657-5008
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-09-16
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Provider Licenses
StateLicense IDTaxonomies
OKPA1512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant