Individual
CANDICE STALLONE TYREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6604 JEFFERSON PAIGE RD, SHREVEPORT, LA 71119-5006
(318) 288-1949
Mailing address
6604 JEFFERSON PAIGE RD, SHREVEPORT, LA 71119-5006
(318) 288-1949
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8099
TRANSPORTATION
LA
Enumeration date
03/07/2019
Last updated
03/07/2019
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