Provider Demographics
NPI:1053571158
Name:KNIGHT, CANDICE LEDUFF (MD)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:LEDUFF
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2190 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1807
Mailing Address - Country:US
Mailing Address - Phone:985-624-3468
Mailing Address - Fax:985-624-3969
Practice Address - Street 1:2190 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1807
Practice Address - Country:US
Practice Address - Phone:985-624-3468
Practice Address - Fax:985-624-3969
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.203396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1094471Medicaid