Provider Demographics
NPI:1518445139
Name:HARRIS, CANDACE BLOUNT
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:BLOUNT
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 SHADES MOUNTAIN PLZ
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1513
Mailing Address - Country:US
Mailing Address - Phone:205-979-3381
Mailing Address - Fax:205-979-3726
Practice Address - Street 1:774 SHADES MOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-1513
Practice Address - Country:US
Practice Address - Phone:205-979-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily