Provider Demographics
NPI:1184023871
Name:FLEMING, CANDACE PARKER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:PARKER
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W LEGION AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2341
Mailing Address - Country:US
Mailing Address - Phone:618-281-4325
Mailing Address - Fax:618-208-1313
Practice Address - Street 1:109 W LEGION AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2341
Practice Address - Country:US
Practice Address - Phone:618-281-4325
Practice Address - Fax:618-208-1313
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical