Provider Demographics
NPI:1013939560
Name:WALKLEY, CANDACE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LYNN
Last Name:WALKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:LYNN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1169 GRAND CENTRAL PKWY BLDG E
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3185
Mailing Address - Country:US
Mailing Address - Phone:936-525-3600
Mailing Address - Fax:
Practice Address - Street 1:1169 GRAND CENTRAL PKWY BLDG E
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3185
Practice Address - Country:US
Practice Address - Phone:936-525-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023916207RI0200X
TXR2781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487538Medicaid
LAH96559Medicare UPIN
LA1487538Medicaid