Provider Demographics
NPI:1962240135
Name:FOREMAN, KANDACE LYNN (NURSE)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:LYNN
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-2112
Mailing Address - Country:US
Mailing Address - Phone:214-304-9009
Mailing Address - Fax:
Practice Address - Street 1:2124 N 8TH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-2112
Practice Address - Country:US
Practice Address - Phone:214-304-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP61648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse