Provider Demographics
NPI:1316743503
Name:GOODWIN, CANDACE (PMHNP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 RUNNING BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6648
Mailing Address - Country:US
Mailing Address - Phone:918-721-3902
Mailing Address - Fax:
Practice Address - Street 1:1200 S AIR DEPOT BLVD STE O
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4848
Practice Address - Country:US
Practice Address - Phone:405-931-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health