Provider Demographics
NPI:1265916936
Name:BROUGHTON, CANDIA MARIE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CANDIA
Middle Name:MARIE
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-974-3447
Mailing Address - Fax:
Practice Address - Street 1:4200 LAWRENCEBURG RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8936
Practice Address - Country:US
Practice Address - Phone:502-227-4821
Practice Address - Fax:502-227-3013
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1084003OtherRN
KY3012693OtherAPRN