Individual provider Active NPI

Candice Nicole Gardner, NP

  • Acute Care Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1881063972
Registry record updated Aug 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
0024172819 Issued in VA
Practice address
401 N 12TH St
Richmond, VA 23298
Phone
(804) 828-9000
NPI assigned
Sep 18, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 0024172819 VA Primary

Addresses

Primary practice location

401 N 12TH St
Richmond, VA 23298

Mailing address

PO Box 91734
Richmond, VA 23291-1734
Phone (804) 358-6100

Other practice location 1

1250 E Marshall St
Richmond, VA 23298-5051
Phone (804) 828-2775

Other names 1

  • Candice Walters Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180629001694 VA Practitioner - Nurse Practitioner 3476859984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1510 N 28TH St
Richmond, VA 23223-5311

5875 Bremo Rd
Richmond, VA 23226-1934

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince May 2, 2022 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince May 2, 2022 Accepting new patients

Locations

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

Interoperability endpoints

  • Direct secure messaging: ngardner1249014@direct.bsmhealth.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535673600000",
    "number": "1881063972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91734",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232911734",
            "telephone_number": "804-358-6100",
            "fax_number": "804-342-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N 12TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23298",
            "telephone_number": "804-828-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Marshall St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985051",
            "country_code": "US",
            "telephone_number": "804-828-2775",
            "fax_number": "804-828-0191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "CANDICE",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-18",
        "last_updated": "2018-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024172819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "WALTERS",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.