Individual
CANDACE C. MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1101 MEDICAL CENTER BLVD, ER, MARRERO, LA 70072-3147
(504) 349-1533
(504) 349-1530
Mailing address
1101 MEDICAL CENTER BLVD, ER, MARRERO, LA 70072-3147
(504) 349-1533
(504) 349-1530
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP07717
LA
363L00000X
Nurse Practitioner
RN113883
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000832752A
—
GA
05
—
000832752B
—
GA
05
—
000832752C
—
GA
05
—
000832752E
—
GA
01
—
10059157
AMERIGROUP
GA
05
—
NP0335
—
SC
Enumeration date
06/23/2006
Last updated
05/14/2014
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