Individual
EMILY J CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
619 S FLEISHEL AVE, TYLER, TX 75701-2004
(903) 606-1264
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
(903) 592-9986
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP118873
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
723802
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1C3376
MEDICARE
TX
05
—
398191220
—
TX
01
—
8MK526
BCBS
TX
01
—
P02469301
MEDICARE RAIL ROAD
TX
Enumeration date
01/25/2010
Last updated
07/27/2023
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