Healthcare Provider Details

I. General information

NPI: 1942634803
Provider Name (Legal Business Name): CANDACE R HUBBARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE WREN FNP

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W SOUTH AVE
WINNFIELD LA
71483-3423
US

IV. Provider business mailing address

PO BOX 1288
WINNFIELD LA
71483-1288
US

V. Phone/Fax

Practice location:
  • Phone: 318-302-3263
  • Fax: 318-648-0378
Mailing address:
  • Phone: 318-209-4501
  • Fax: 318-648-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07541
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: