Provider Demographics
NPI:1568844728
Name:LEACH, CANDICE S (FNP-C)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:S
Last Name:LEACH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2062
Mailing Address - Country:US
Mailing Address - Phone:318-259-5080
Mailing Address - Fax:318-259-5652
Practice Address - Street 1:121 WATTS ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2062
Practice Address - Country:US
Practice Address - Phone:318-259-5080
Practice Address - Fax:318-259-5652
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily