Provider Demographics
NPI:1992947220
Name:MCINTOSH, CANDRA C (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CANDRA
Middle Name:C
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11085 MONTGOMERY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2395
Mailing Address - Country:US
Mailing Address - Phone:513-547-2861
Mailing Address - Fax:
Practice Address - Street 1:11085 MONTGOMERY RD STE 250
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2395
Practice Address - Country:US
Practice Address - Phone:513-547-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH330155163WP0200X
OH0034455363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics