Provider Demographics
NPI:1932063583
Name:BOLDEN, CANDACE FAITH
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:FAITH
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 VAN BUREN AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3847
Mailing Address - Country:US
Mailing Address - Phone:662-425-6865
Mailing Address - Fax:
Practice Address - Street 1:425 VAN BUREN AVE APT 8
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3847
Practice Address - Country:US
Practice Address - Phone:662-425-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-09
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered