Provider Demographics
NPI:1083869218
Name:PRINGLE-WELCH, CANDACE (FNP, CNM)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:PRINGLE-WELCH
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:PRINGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 DAVIS STREET
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5708
Mailing Address - Country:US
Mailing Address - Phone:601-693-0118
Mailing Address - Fax:601-553-8175
Practice Address - Street 1:2701 DAVIS STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5708
Practice Address - Country:US
Practice Address - Phone:601-693-0118
Practice Address - Fax:601-553-8175
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05275328Medicaid
MS05275328Medicaid