Provider Demographics
NPI:1699538124
Name:CANDICE MYERS, LLC
Entity type:Organization
Organization Name:CANDICE MYERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, WHNP
Authorized Official - Phone:337-519-1249
Mailing Address - Street 1:112 SWEETWATER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5779
Mailing Address - Country:US
Mailing Address - Phone:337-519-1249
Mailing Address - Fax:
Practice Address - Street 1:814 FORTUNE RD STE 108
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5542
Practice Address - Country:US
Practice Address - Phone:337-573-4132
Practice Address - Fax:337-573-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty