MEDICARE: CANDACE MICHELE CRAVEN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	14178	TN

General Provider Information

NPI Number	:	1114258746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE MICHELE CRAVEN NP-C

Provider Business Mailing Address
First Line	:	3852 CANDIES CREEK LANE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1863
Country	:	US
Telephone Number	:	423-339-6735
Fax Number	:

Provider Business Practice Location Address
First Line	:	9408 APISON PIKE STE 174
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-5977
Country	:	US
Telephone Number	:	423-396-9894
Fax Number	:	423-396-9508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	07/07/2015

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