| Doctor Name: | CANDACE D KOIRTH |
| NPI Number: | 1710082508 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | 45129 |
| Business Practice Address: | 124 Commodore St Suite A Pratt, KS - 671242901 |
| Business Phone Number: | 8889007762 |
| Business Fax Number: | 6204501371 |
| Mailing Address: | 124 Commodore St, Suite A PRATT |
| State: | KS |
| Postal Code: | 671242901 |
| Phone Number: | 8889007762 |
| Fax Number: | 6204501371 |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 09/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 45129 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |