Provider Demographics
NPI:1598227779
Name:BROWN, CANDYCE (APRN)
Entity Type:Individual
Prefix:
First Name:CANDYCE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CANDYCE
Other - Middle Name:
Other - Last Name:MUSGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 DR MICHAEL DEBAKEY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5888
Mailing Address - Country:US
Mailing Address - Phone:337-478-9331
Mailing Address - Fax:337-478-9828
Practice Address - Street 1:333 DR MICHAEL DEBAKEY DR STE 220
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5888
Practice Address - Country:US
Practice Address - Phone:337-478-9331
Practice Address - Fax:337-478-9828
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204527363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health