Provider Demographics
NPI:1871876128
Name:JOHNSON, KANDACE (NP)
Entity type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KANDACE
Other - Middle Name:
Other - Last Name:BUSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13639 CREEKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9599
Mailing Address - Country:US
Mailing Address - Phone:317-690-2577
Mailing Address - Fax:
Practice Address - Street 1:5189 W 600 N
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9715
Practice Address - Country:US
Practice Address - Phone:317-329-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007867A363LG0600X, 363LA2200X
IN28161137A163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health