Healthcare Provider Details

I. General information

NPI: 1467361378
Provider Name (Legal Business Name): CANDACE L LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E GILMAN RD
LAFAYETTE LA
70501-3510
US

IV. Provider business mailing address

102 E GILMAN RD
LAFAYETTE LA
70501-3510
US

V. Phone/Fax

Practice location:
  • Phone: 337-442-3863
  • Fax:
Mailing address:
  • Phone: 337-442-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: