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General NPI Number Information
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NPI Number | 1720754476
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Entity Type | Individual
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Provider Name | CANDICE LEIGH HEAVENER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 24111 HIGHWAY 15
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City | TIPLERSVILLE
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State | MS
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Zip | 38674
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Country | US
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Telephone | 662-882-3635
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Fax | 662-235-9157
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Provider Business Mailing Address
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Address Line | 2820 COUNTY ROAD 301
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City | FALKNER
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State | MS
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Zip | 38629-9321
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Country | US
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Telephone | 662-882-3635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 30118
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 907123
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License Number State | MS
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