Provider Demographics
NPI:1528628542
Name:RYAN, CANDICE STARR (NP-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:STARR
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0986
Mailing Address - Country:US
Mailing Address - Phone:919-575-6103
Mailing Address - Fax:919-575-6817
Practice Address - Street 1:1614 NC HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8297
Practice Address - Country:US
Practice Address - Phone:919-575-6103
Practice Address - Fax:919-575-6817
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner