Provider Demographics
NPI:1598256497
Name:VALMONT, CANDICE MIRANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:MIRANDA
Last Name:VALMONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MIRANDA
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3417 U OF A WAY
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1419
Mailing Address - Country:US
Mailing Address - Phone:870-799-6000
Mailing Address - Fax:870-799-6093
Practice Address - Street 1:300 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5207
Practice Address - Country:US
Practice Address - Phone:870-799-6000
Practice Address - Fax:870-799-6093
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680132390200000X
ARE-12586207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program