Provider Demographics
NPI:1558466847
Name:THOMPSON, CANDITA ROGERS (NP)
Entity Type:Individual
Prefix:
First Name:CANDITA
Middle Name:ROGERS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N CAUSEWAY BLVD STE 2200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-8306
Mailing Address - Country:US
Mailing Address - Phone:504-301-7679
Mailing Address - Fax:504-301-7679
Practice Address - Street 1:3838 N CAUSEWAY BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-8306
Practice Address - Country:US
Practice Address - Phone:504-301-7679
Practice Address - Fax:504-301-7679
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN081036363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1628620Medicaid
LA4H578Medicare ID - Type Unspecified
Q49717Medicare UPIN