Provider Demographics
NPI:1760878474
Name:BELMONT, CANDISE (APRN)
Entity Type:Individual
Prefix:
First Name:CANDISE
Middle Name:
Last Name:BELMONT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 WILMA RUDOLPH BLVD # C247
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6161
Mailing Address - Country:US
Mailing Address - Phone:931-221-2881
Mailing Address - Fax:866-886-8183
Practice Address - Street 1:103 JEFFERSON ST STE 100
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-221-2881
Practice Address - Fax:866-886-8183
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19905363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health