Provider Demographics
NPI:1720790066
Name:SKELTON, CANDACE (RN)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:RN
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 649
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:713-857-4371
Mailing Address - Fax:
Practice Address - Street 1:4415 DENMERE CT
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-5408
Practice Address - Country:US
Practice Address - Phone:713-857-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX774445163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-RiskGroup - Single Specialty