Provider Demographics
NPI:1720694516
Name:CHRISTIAN, CANDACE (NP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:NP
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 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-5742
Mailing Address - Fax:423-726-2669
Practice Address - Street 1:390 KANE ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-2753
Practice Address - Country:US
Practice Address - Phone:276-386-3411
Practice Address - Fax:276-386-3492
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily