Provider Demographics
NPI:1467583021
Name:ROWLAND, CANDACE MAYBERRY (APN)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MAYBERRY
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MURRAY GUARD DR STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3751
Mailing Address - Country:US
Mailing Address - Phone:731-574-9779
Mailing Address - Fax:
Practice Address - Street 1:16 MURRAY GUARD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3751
Practice Address - Country:US
Practice Address - Phone:731-574-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505976Medicaid
36409731Medicare PIN
TN1505976Medicaid