CANDACE DONYUSHA CHARLES (NPI# 1922284504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922284504 |
| Entity Type | Individual |
| Full Name | CANDACE DONYUSHA CHARLES |
| Other Name | CANDACE DONYUSHA MOSES |
| Credential | PA |
| Practice Address |
4965 Stone Falls Ctr Ste 7 O Fallon IL 62269-7803 |
| Mailing Address |
3 Professional Dr Ste B Alton IL 62002-5067 |
| Practice Telephone | 6187262500 |
| Mailing Telephone | 6184657177 |
| Mailing Fax Number | 6184657176 |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2018-08-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085004583 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4965 STONE FALLS CTR STE 7 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-7803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609293372 | Bethany Ilene Bowen | Nurse Practitioner | 4965 Stone Falls Ctr Ste 7, O Fallon, IL 62269-7803 | 2014-03-19 |
| 1134451834 | Kathy Kinder | Mechanotherapist | 4965 Stone Falls Ctr Ste 7, O Fallon, IL 62269-7802 | 2010-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437787272 | Madeline Kruper | Physician Assistant | 975 Emge Rd, O Fallon, MO 63366-2122 | 2020-03-28 |
| 1457854630 | Hallie Ann France | Physician Assistant | Three Saint Elizabeth Blvd, O Fallon, IL 62269-1281 | 2018-03-14 |
| 1902293004 | Casey Wegener | Physician Assistant | 7136 S Outer 364, O Fallon, MO 63368-7756 | 2015-04-16 |
| 1902916851 | Tina Ann Cloin | Physician Assistant | 310 N 7 Hills Rd Ste 220, O Fallon, IL 62269-4111 | 2006-08-30 |
| 1063034783 | Regency Mark Medical Group LLC | Physician Assistant | 124 Regency Park Ste 7, O Fallon, IL 62269-1994 | 2020-05-15 |
| 1558906750 | Nicole Dawn Brueggemann | Physician Assistant | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-11-12 |
| 1295378610 | Kody Alan Hindman | Physician Assistant | 3 Saint Elizabeth Blvd, O Fallon, IL 62269-1281 | 2019-10-18 |
| 1912548587 | Adela Redzic | Physician Assistant | 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 | 2019-10-03 |
| 1962973982 | Kelsey Koenig | Physician Assistant | 310 N 7 Hills Rd Ste 220, O Fallon, IL 62269-4111 | 2018-12-17 |
| 1245752211 | Joseph Edward Scott | Physician Assistant | 3 Saint Elizabeth Blvd Ste 5000, O Fallon, IL 62269-1282 | 2017-07-12 |
| Find all providers in O FALLON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.