Provider Demographics
NPI:1184857781
Name:CAIN, CANDY K (LPN)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:K
Last Name:CAIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8718
Mailing Address - Country:US
Mailing Address - Phone:386-481-3198
Mailing Address - Fax:
Practice Address - Street 1:4052 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8718
Practice Address - Country:US
Practice Address - Phone:386-481-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN097898164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse