Provider Demographics
NPI:1699495408
Name:ATKINSON, CANDY CAROL
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:CAROL
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5692 STATE ROUTE 374
Mailing Address - Street 2:
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920-4702
Mailing Address - Country:US
Mailing Address - Phone:518-521-0873
Mailing Address - Fax:
Practice Address - Street 1:PLATTSBURGH MEDICAL CARE
Practice Address - Street 2:675 STATE RTE 3 #1
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1290
Practice Address - Country:US
Practice Address - Phone:518-566-0672
Practice Address - Fax:518-324-2210
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily