Healthcare Provider Details

I. General information

NPI: 1295649168
Provider Name (Legal Business Name): CANDICE LASHAE TODD MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 MADISON AVE
MEMPHIS TN
38104-2447
US

IV. Provider business mailing address

1603 GWYNN RD
NESBIT MS
38651-8828
US

V. Phone/Fax

Practice location:
  • Phone: 901-346-4350
  • Fax:
Mailing address:
  • Phone: 901-598-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908807
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number43129
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: