Provider Demographics
NPI:1003073990
Name:BIVENS, KANDACE DANIELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:DANIELLE
Last Name:BIVENS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KANDACE
Other - Middle Name:DANIELLE
Other - Last Name:ALLEN MARKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2674
Mailing Address - Country:US
Mailing Address - Phone:478-453-9346
Mailing Address - Fax:
Practice Address - Street 1:800 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2674
Practice Address - Country:US
Practice Address - Phone:478-453-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1722363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA899248448AMedicaid
GA899248448BMedicaid