Provider Demographics
NPI:1831640564
Name:NEELEY, CANDACE PAIGE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:PAIGE
Last Name:NEELEY
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:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:WELEETKA
Mailing Address - State:OK
Mailing Address - Zip Code:74880-0278
Mailing Address - Country:US
Mailing Address - Phone:405-786-2203
Mailing Address - Fax:405-786-2625
Practice Address - Street 1:302 E. 6TH STREET
Practice Address - Street 2:
Practice Address - City:WELEETKA
Practice Address - State:OK
Practice Address - Zip Code:74880-0278
Practice Address - Country:US
Practice Address - Phone:405-786-2203
Practice Address - Fax:405-786-2625
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker