Provider Demographics
NPI:1720722929
Name:JACKSON, CANDICE GRACE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:GRACE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 JASMINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1730
Mailing Address - Country:US
Mailing Address - Phone:334-450-3581
Mailing Address - Fax:
Practice Address - Street 1:701 JASMINE HILL RD
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1730
Practice Address - Country:US
Practice Address - Phone:334-450-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program