Provider Demographics
NPI:1093243446
Name:STEVENS, CANDICE DENISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:DENISE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7016
Mailing Address - Country:US
Mailing Address - Phone:606-836-0202
Mailing Address - Fax:606-836-2189
Practice Address - Street 1:122 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7016
Practice Address - Country:US
Practice Address - Phone:606-836-0202
Practice Address - Fax:606-836-2189
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020874363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care