Individual
KANAYOCHUKWU KANNY JACQUELYNE ANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6048 LAKE WORTH BLVD, FORT WORTH, TX 76135-3706
(817) 270-4243
(817) 270-4249
Mailing address
6100 HARRIS PARKWAY, SUITE 380, FORT WORTH, TX 76132
(817) 759-9008
(844) 583-5414
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
54922-20
WI
208600000X
Surgery Physician
MD204301
LA
208600000X
Surgery Physician
Primary
N9800
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343872301
—
TX
05
—
343872302
—
TX
Enumeration date
11/03/2007
Last updated
08/04/2017
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