Provider Demographics
NPI:1043961246
Name:DIXON, CANDACE NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:NICOLE
Last Name:DIXON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:CANDACE
Other - Middle Name:NICOLE
Other - Last Name:DIEMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6432 E 34TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2537
Mailing Address - Country:US
Mailing Address - Phone:316-260-8700
Mailing Address - Fax:316-201-1071
Practice Address - Street 1:6432 E 34TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2537
Practice Address - Country:US
Practice Address - Phone:316-260-8700
Practice Address - Fax:316-201-1071
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80820-112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health