Healthcare Provider Details

I. General information

NPI: 1346755444
Provider Name (Legal Business Name): CANDACE H NICHOLS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 MASONIC DR
ALEXANDRIA LA
71301-3841
US

IV. Provider business mailing address

PO BOX 369
BOYCE LA
71409-0369
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-6827
  • Fax:
Mailing address:
  • Phone: 318-277-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP01196
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number43449-1196
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: