Provider Demographics
NPI:1346001633
Name:NEWBOLD, CANDACE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:NEWBOLD
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 DAGGETT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1130
Mailing Address - Country:US
Mailing Address - Phone:541-274-8400
Mailing Address - Fax:
Practice Address - Street 1:383 N 1940 W
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-8188
Practice Address - Country:US
Practice Address - Phone:801-309-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10024447363LP2300X
UT10591236-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily