Kandis Danielle Fordham, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-07636 Issued in NC

Practice address

556 Sandhurst Dr
Fayetteville, NC 28304-4426

Phone

(910) 483-2646

NPI assigned

Oct 4, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kandis.atkins.1@29216.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cumberland County Hospital System Inc

  dba Oncology Services

  • Hematology & Oncology Physician
  • Fayetteville, NC
  • NPI 1881946242
  Medicare reassignment
• Cumberland County Hospital System Inc

  dba CFV-Harnett Hospitalist Group

  • Hospitalist Physician
  • Dunn, NC
  • NPI 1124426804
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1417467408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "556 SANDHURST DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044426",
            "telephone_number": "910-483-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "556 SANDHURST DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044426",
            "telephone_number": "910-483-2646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1095 N Bragg Blvd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Spring Lake",
            "state": "NC",
            "postal_code": "283903307",
            "country_code": "US",
            "telephone_number": "910-339-6015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORDHAM",
        "first_name": "KANDIS",
        "middle_name": "DANIELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-04",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07636",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NC",
            "license": "0010-07636",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tonya Nicole Ford, LMBT
• Mellissa Forde-Jackson, LCSW
• Joycelyn Ann-Marie Forde
• Brandon James Fordham, PA-C
• Colby Edward Fordham, PT
• Forever Young Group Care
• Forever Young Group Care LLC
• Forever Young Group Care, LLC
• Mary Rebecca Forgach, PA-C
• Forged by Fire Counseling Services, LLC (Mary Lynn Campbell)

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.