Provider Demographics
NPI:1720754476
Name:HEAVENER, CANDICE LEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LEIGH
Last Name:HEAVENER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 COUNTY ROAD 301
Mailing Address - Street 2:
Mailing Address - City:FALKNER
Mailing Address - State:MS
Mailing Address - Zip Code:38629-9321
Mailing Address - Country:US
Mailing Address - Phone:662-882-3635
Mailing Address - Fax:
Practice Address - Street 1:24111 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:TIPLERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38674
Practice Address - Country:US
Practice Address - Phone:662-882-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30118363LF0000X
MS907123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily