Provider Demographics
NPI:1730968223
Name:STEPHENS, CANDANCE DESIREE
Entity type:Individual
Prefix:
First Name:CANDANCE
Middle Name:DESIREE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 E SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-1471
Mailing Address - Country:US
Mailing Address - Phone:940-727-1128
Mailing Address - Fax:
Practice Address - Street 1:1957 E SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-1471
Practice Address - Country:US
Practice Address - Phone:940-727-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer