Individual
JESSICA A CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
400 PALMETTO HEALTH PKWY, COLUMBIA, SC 29212-1760
(803) 434-6771
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1914
SC
363LA2200X
Adult Health Nurse Practitioner
Primary
1914
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1514
—
SC
Enumeration date
08/15/2006
Last updated
01/26/2021
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