Provider Demographics
NPI:1710242466
Name:ASHLEY, CANDICE M (CFNP-BC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:M
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:CFNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-8407
Mailing Address - Country:US
Mailing Address - Phone:601-845-6602
Mailing Address - Fax:601-845-6164
Practice Address - Street 1:218 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-8407
Practice Address - Country:US
Practice Address - Phone:601-845-6602
Practice Address - Fax:601-845-6164
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily