Basic Information
| Provider Information | |||||||||
| NPI: | 1497709786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKEEN | ||||||||
| FirstName: | CANDICE | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7502 STATE RD | ||||||||
| Address2: | MOB II STE. 2210 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452552596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137514222 | ||||||||
| FaxNumber: | 5137514353 | ||||||||
| Practice Location | |||||||||
| Address1: | 7502 STATE RD | ||||||||
| Address2: | MOB II STE. 2210 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452552596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137514222 | ||||||||
| FaxNumber: | 5137514353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50002135 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.