Provider Demographics
NPI:1578236113
Name:FORTE, CANDICE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:FORTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:ALLUMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:821 E PARK ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:AR
Practice Address - Zip Code:72024-9024
Practice Address - Country:US
Practice Address - Phone:870-552-7303
Practice Address - Fax:870-552-7719
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily