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General NPI Number Information
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NPI Number | 1558994491
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Entity Type | Individual
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Provider Name | CANDICE SHERESE STALLWORTH MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2301 MEDPARK DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2288
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Country | US
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Telephone | 252-962-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 MEDPARK DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2288
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Country | US
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Telephone | 252-962-5410
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 232478
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5013060
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License Number State | NC
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