=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336266220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDICE M MILLER NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 06/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 WEBER ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70538-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-828-2550
-----------------------------------------------------
Fax | 337-355-2335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 WEBER ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70538-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-828-2550
-----------------------------------------------------
Fax | 337-355-2335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN081159
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP5152
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | AP5152
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------