Individual
CANDYCE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3636 EXECUTIVE CENTER DR STE G70, AUSTIN, TX 78731-1628
(512) 371-9555
(512) 367-5756
Mailing address
3636 EXECUTIVE CENTER DR STE G70, AUSTIN, TX 78731-1628
(512) 371-9555
(512) 367-5756
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
860008
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP143520
TX
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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