Provider Demographics
NPI:1427435932
Name:WEBSTER, KANDACE DIANE (APRN)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:DIANE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1010
Mailing Address - Country:US
Mailing Address - Phone:270-384-4764
Mailing Address - Fax:270-384-6228
Practice Address - Street 1:810 JAMESTOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1010
Practice Address - Country:US
Practice Address - Phone:270-384-4764
Practice Address - Fax:270-384-6228
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008931363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100351010Medicaid