Provider Demographics
NPI:1720708530
Name:HALE, KANDYCE SHEA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:KANDYCE
Middle Name:SHEA
Last Name:HALE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 VELTA LN APT 11501
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3349
Mailing Address - Country:US
Mailing Address - Phone:325-998-2889
Mailing Address - Fax:
Practice Address - Street 1:1924 PINE ST STE 401
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-676-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091683363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal