Provider Demographics
NPI:1396209557
Name:BRITTON, CANDICE LEAANN (MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:LEAANN
Last Name:BRITTON
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:MISS
Other - First Name:CANDICE
Other - Middle Name:LEAANN
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:2208 SWANNANOA AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3631
Mailing Address - Country:US
Mailing Address - Phone:423-765-6480
Mailing Address - Fax:
Practice Address - Street 1:1041 HAMILTON PL
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7917
Practice Address - Country:US
Practice Address - Phone:770-572-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000003685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant