Provider Demographics
NPI:1649581844
Name:SMITH, CANDISE M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CANDISE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0339
Mailing Address - Country:US
Mailing Address - Phone:256-739-9593
Mailing Address - Fax:256-739-2984
Practice Address - Street 1:401 ARNOLD ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1968
Practice Address - Country:US
Practice Address - Phone:256-739-9593
Practice Address - Fax:256-739-2984
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-108588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner