Provider Demographics
NPI:1992266241
Name:VIELMA, CANDACE (AG-CNS)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:VIELMA
Suffix:
Gender:F
Credentials:AG-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BUNTON CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5701
Mailing Address - Country:US
Mailing Address - Phone:512-268-2091
Mailing Address - Fax:512-268-2190
Practice Address - Street 1:135 BUNTON CREEK RD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5787
Practice Address - Country:US
Practice Address - Phone:512-264-4275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139733364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology