Provider Demographics
NPI:1053078659
Name:CAMPBELL, CANDACE LEIA (RN)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LEIA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FOX AND HOUND WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-8074
Mailing Address - Country:US
Mailing Address - Phone:423-532-8105
Mailing Address - Fax:
Practice Address - Street 1:135 FOX AND HOUND WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-532-8105
Practice Address - Fax:423-532-8112
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN209225163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)