Provider Demographics
NPI:1780752592
Name:ERVEN, CANDI D (FNP)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:D
Last Name:ERVEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4682
Mailing Address - Country:US
Mailing Address - Phone:417-889-0056
Mailing Address - Fax:
Practice Address - Street 1:3045 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4682
Practice Address - Country:US
Practice Address - Phone:417-889-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
431560263004OtherTRICARE
MO428408215Medicaid
P00113023OtherRAILROAD MEDICARE
MO480013268Medicare PIN
MO428408215Medicaid