Individual
CANDICE CROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 330-7000
Mailing address
1520 LEANNE LOOP, BASTROP, LA 71220-6104
(318) 368-5144
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
207014
LA
363LG0600X
Gerontology Nurse Practitioner
Primary
207014
LA
Other
Enumeration date
10/26/2020
Last updated
11/11/2020
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