Individual
MRS. COLLEEN G CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 N STATE ST, DIVISION OF INFECTIOUS DISEASE, JACKSON, MS 39216-4500
(601) 984-5560
(601) 984-5565
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5560
(601) 984-5565
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R850953
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08153779
—
MS
01
—
P00815217
RAILROAD MEDICARE ID
MS
01
—
P01233199
RAILROAD MEDICARE
MS
01
—
R850953
NURSING LICENSE NUMBER
MS
Enumeration date
06/26/2006
Last updated
11/18/2014
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