Individual
DUSTIN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
737B NORTH DRIVE, HOPKINSVILLE, KY 42240
(270) 890-1780
(270) 890-1789
Mailing address
3999 FORT CAMPBELL BLVD, HOPKINSVILLE, KY 42240-4929
(270) 886-2205
(270) 886-0392
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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