Doctor Name: | CANDICE PUCKETT KEY |
NPI Number: | 1467444679 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNPC |
License Number: | 201946 |
Business Practice Address: | Newsome Family Practice 304 Mountainview Road King, NC - 27021 |
Business Phone Number: | 3367162255 |
Business Fax Number: | 3369833016 |
Mailing Address: | Po Box 344, WINSTON SALEM |
State: | NC |
Postal Code: | 271020344 |
Phone Number: | 3367162255 |
Fax Number: | 3369833016 |
NPI Enumeration Date: | 08/16/2005 |
NPI Last Update Date: | 09/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 201946 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |