Provider Demographics
NPI:1912600453
Name:JOHNSTON, CANDACE NICHOLE (CD-PIC, CFD, CPD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:NICHOLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CD-PIC, CFD, CPD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 KIMBALL LN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5616
Mailing Address - Country:US
Mailing Address - Phone:423-637-6481
Mailing Address - Fax:
Practice Address - Street 1:109 JOHNSTON PARK RD
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397
Practice Address - Country:US
Practice Address - Phone:423-637-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula