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General NPI Number Information
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NPI Number | 1649816307
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Entity Type | Organization
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Legal Business Name | CANDLELIGHT CARE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 190 S COLLINS RD STE 100
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City | SUNNYVALE
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State | TX
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Zip | 75182-4623
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Country | US
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Telephone | 214-542-1907
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Fax | 661-221-7156
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Provider Business Mailing Address
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Address Line | 3919 POPLAR POINT DR
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City | ROCKWALL
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State | TX
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Zip | 75032-9276
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Country | US
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Telephone | 214-542-1907
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Fax | 661-221-7158
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | MONDE M FERGUSON
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Credential | FNP
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Telephone | 214-542-1907
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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 |
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License Number State |
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