Provider Demographics
NPI:1689001307
Name:PAGE, KANDACE BURNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:BURNETTE
Last Name:PAGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 SMITH CORNERS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3827
Mailing Address - Country:US
Mailing Address - Phone:704-688-9650
Mailing Address - Fax:704-688-9651
Practice Address - Street 1:7004 SMITH CORNERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3827
Practice Address - Country:US
Practice Address - Phone:704-688-9650
Practice Address - Fax:704-688-9651
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily