Kandice Wallis

NPI #1023412012 in Ada, Oklahoma

Provider Information

NPI Number: 1023412012
Entity Type: Individual
Name: Kandice Wallis
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Case Manager/Care Coordinator
Enumeration Date: Oct 20, 2014
Last Updated: Oct 20, 2014

Practice Location

Address: 314 S. BROADWAY ST.
Address 2: STE. 106
City: Ada
State: Oklahoma
ZIP Code: 74820
Phone: (888) 272-0210

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Manager/Care Coordinator	171M00000X	Primary

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