Individual
MICKEY ALAN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 W MONROE ST APT 4H, GRENADA, MS 38901-5031
(662) 983-0487
Mailing address
1010 W MONROE ST APT 4H, GRENADA, MS 38901-5031
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
908516
MS
Other
Enumeration date
08/04/2026
Last updated
08/04/2026
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