Healthcare Provider Details

I. General information

NPI: 1598227779
Provider Name (Legal Business Name): CANDYCE BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDYCE MUSGROVE

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DR MICHAEL DEBAKEY DR STE 301
LAKE CHARLES LA
70601-5864
US

IV. Provider business mailing address

401 DR MICHAEL DEBAKEY DR STE 301
LAKE CHARLES LA
70601-5864
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-9331
  • Fax: 337-478-9828
Mailing address:
  • Phone: 337-478-9331
  • Fax: 337-478-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number204527
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: