Provider Demographics
NPI:1295964757
Name:COVINGTON, CANDACE YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:YVONNE
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CANDACE
Other - Middle Name:YVONNE
Other - Last Name:WILLIAMS-COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:202 SW 25TH AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8242
Mailing Address - Country:US
Mailing Address - Phone:940-325-4925
Mailing Address - Fax:940-325-4955
Practice Address - Street 1:202 SW 25TH AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8242
Practice Address - Country:US
Practice Address - Phone:940-325-4925
Practice Address - Fax:940-325-4955
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20033615208600000X
TXN3581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB102741Medicare PIN