Provider Demographics
NPI:1750991311
Name:CAIN, CANDACE CAROLYNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:CAROLYNE
Last Name:CAIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744
Mailing Address - Country:US
Mailing Address - Phone:662-552-0117
Mailing Address - Fax:
Practice Address - Street 1:1538 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:EUPORA
Practice Address - State:MS
Practice Address - Zip Code:39744
Practice Address - Country:US
Practice Address - Phone:662-258-7533
Practice Address - Fax:662-258-7534
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily