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General NPI Number Information
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NPI Number | 1306516893
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Entity Type | Individual
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Provider Name | CANDICE NICOLE BLACKWOOD FNP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 2424 DANVILLE RD SW STE K
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City | DECATUR
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State | AL
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Zip | 35603-4219
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Country | US
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Telephone | 256-309-5850
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Fax | 256-309-5851
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Provider Business Mailing Address
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Address Line | 61 COUNTY ROAD 390
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City | TRINITY
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State | AL
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Zip | 35673-3162
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Country | US
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Telephone | 256-345-8232
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-156478
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License Number State | AL
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