Provider Demographics
NPI:1780234690
Name:FLOURNOY, CANDACE MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:MICHELLE
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MICHELLE
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 W GORE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6350
Mailing Address - Country:US
Mailing Address - Phone:580-250-6555
Mailing Address - Fax:
Practice Address - Street 1:3201 W GORE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6350
Practice Address - Country:US
Practice Address - Phone:580-250-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily