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General NPI Number Information
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NPI Number | 1104320803
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Entity Type | Individual
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Provider Name | CANDICE CAMPBELL APN
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 202 JOE AVE
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City | HOHENWALD
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State | TN
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Zip | 38462-2002
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Country | US
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Telephone | 931-796-9797
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Fax | 931-295-0200
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Provider Business Mailing Address
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Address Line | 912 W COLLEGE ST
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City | PULASKI
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State | TN
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Zip | 38478-3630
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Country | US
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Telephone | 931-424-9797
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Fax | 931-424-9788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 24040
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 24040
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License Number State | TN
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