Provider Demographics
NPI:1881017457
Name:CANDACE J TEMPLETON LLC
Entity Type:Organization
Organization Name:CANDACE J TEMPLETON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:TEMPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-248-8728
Mailing Address - Street 1:915 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2638
Mailing Address - Country:US
Mailing Address - Phone:865-248-8728
Mailing Address - Fax:865-248-8782
Practice Address - Street 1:915 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2638
Practice Address - Country:US
Practice Address - Phone:865-248-8728
Practice Address - Fax:865-248-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-01
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005512Medicaid
TN103G700797Medicare PIN