Provider Demographics
NPI:1942634803
Name:HUBBARD, CANDACE R (NP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-1288
Mailing Address - Country:US
Mailing Address - Phone:318-209-4501
Mailing Address - Fax:318-648-0378
Practice Address - Street 1:403 W SOUTH AVE
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3423
Practice Address - Country:US
Practice Address - Phone:318-302-3263
Practice Address - Fax:318-648-0378
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily