Individual
CANDACE J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
755 S BECKHAM AVE, TYLER, TX 75701-1903
(903) 534-4684
Mailing address
755 S BECKHAM AVE, TYLER, TX 75701-1903
(903) 534-4684
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
314255
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
341255
LVN
TX
Enumeration date
02/21/2020
Last updated
02/21/2020
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