Provider Demographics
NPI:1760017651
Name:RIVERS, KANDICE (DNP, APRN-BC, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:KANDICE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:DNP, APRN-BC, PMHNP
Other - Prefix:DR
Other - First Name:KANDICE
Other - Middle Name:
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KANDICE RIVERS
Mailing Address - Street 1:8504 CHLOE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-8100
Mailing Address - Country:US
Mailing Address - Phone:843-452-1470
Mailing Address - Fax:
Practice Address - Street 1:2365 IRON POINT RD STE 210
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8713
Practice Address - Country:US
Practice Address - Phone:925-360-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.23549363LP0808X
SC23549363LP0808X
CA95014958363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health