Healthcare Provider Details

I. General information

NPI: 1013771138
Provider Name (Legal Business Name): CANDICE ESCHETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N ACADIA RD
THIBODAUX LA
70301-4823
US

IV. Provider business mailing address

158 MILLSTONE DR
THIBODAUX LA
70301-3980
US

V. Phone/Fax

Practice location:
  • Phone: 985-493-4727
  • Fax:
Mailing address:
  • Phone: 985-790-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number234470
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: