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Individual
CANDACE C CHIDESTER
Active
Individual
CANDACE C CHIDESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12467
WV
208D00000X
General Practice Physician
12467
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721214
BC
WV
05
—
0050726000
—
WV
Enumeration date
12/12/2006
Last updated
02/23/2011
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