Individual
CANDYCE MARIE MEDLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
904 NW 4TH ST, STIGLER, OK 74462-1653
(918) 967-8223
Mailing address
904 NW 4TH ST, STIGLER, OK 74462-1653
(918) 967-8223
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100733860B
—
OK
05
—
200507310A
—
OK
Enumeration date
10/18/2016
Last updated
10/18/2016
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