MEDICARE: TWICE AS NICE MEDICAL CLINIC

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	AP126756	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP121596	TX

General Provider Information

NPI Number	:	1407201197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWICE AS NICE MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	6 WOODMONT CROSSING ST
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2100
Country	:	US
Telephone Number	:	903-836-1016
Fax Number	:	903-831-0162

Provider Business Practice Location Address
First Line	:	6 WOODMONT CROSSING ST
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2100
Country	:	US
Telephone Number	:	903-826-4404
Fax Number	:

Authorized Official
Title or Position	:	ADVANCED NURSE PRACTITIONER
Name	:	CANDACE ANN CHAUNCY
Credential	:	ACNP-BC
Telephone Number	:	903-831-0161

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	10/11/2021

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1689604738 — ELIZABETH KATE MCCULLEY MS LPC
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Directions to “TWICE AS NICE MEDICAL CLINIC ” Practice Location

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