Provider Demographics
NPI:1144097023
Name:FARRAR, CANDACE LETARA
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:LETARA
Last Name:FARRAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 EASTCHESTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2660
Mailing Address - Country:US
Mailing Address - Phone:336-521-9480
Mailing Address - Fax:336-232-1762
Practice Address - Street 1:1380 EASTCHESTER DR STE 103
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2660
Practice Address - Country:US
Practice Address - Phone:336-521-9480
Practice Address - Fax:336-232-1762
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019249363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology