Provider Demographics
NPI:1679824973
Name:JUDKINS, CANDANCE EUNGENIA
Entity Type:Individual
Prefix:
First Name:CANDANCE
Middle Name:EUNGENIA
Last Name:JUDKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SMITH GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-5586
Mailing Address - Country:US
Mailing Address - Phone:205-747-7957
Mailing Address - Fax:
Practice Address - Street 1:129 E PARK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3000
Practice Address - Country:US
Practice Address - Phone:205-747-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135397163W00000X, 163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult