Provider Demographics
NPI:1225462039
Name:CANNON, JENNIFER LYNN (CNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:CANNON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NC 54
Mailing Address - Street 2:APT. 605
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1600
Mailing Address - Country:US
Mailing Address - Phone:919-260-3062
Mailing Address - Fax:
Practice Address - Street 1:201 NC 54
Practice Address - Street 2:APT 605
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1600
Practice Address - Country:US
Practice Address - Phone:919-260-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4005443747P1801X, 372600000X, 372500000X, 374U00000X, 376K00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker