Provider Demographics
NPI:1578807061
Name:ADKINS, CANDICE ERIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:ERIN
Last Name:ADKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CANDICE
Other - Middle Name:ERIN
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:117 CROSSFIELD DR STE B
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1844
Practice Address - Country:US
Practice Address - Phone:859-873-9188
Practice Address - Fax:859-873-0870
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1957363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100386470Medicaid