Provider Demographics
NPI:1679205140
Name:BENFORD, CANDACE DANIELLE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:DANIELLE
Last Name:BENFORD
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-627-7225
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:DEPT PSYCHIATRY, STE 141A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-627-7225
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022034853363LP0808X
MO2003021366363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420115486Medicaid