Provider Demographics
NPI:1740754027
Name:SHOWS, CANDICE BROOKE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:BROOKE
Last Name:SHOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PARTNERSHIP WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-4502
Mailing Address - Country:US
Mailing Address - Phone:601-736-6443
Mailing Address - Fax:601-736-2543
Practice Address - Street 1:104 PARTNERSHIP WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-4502
Practice Address - Country:US
Practice Address - Phone:601-736-6443
Practice Address - Fax:601-736-2543
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner