Provider Demographics
NPI:1407234214
Name:MYERS, CANDICE (WHNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:WHNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 FORTUNE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5542
Mailing Address - Country:US
Mailing Address - Phone:337-573-4132
Mailing Address - Fax:337-573-4161
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08271363LP0808X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health