Provider Demographics
NPI:1225798671
Name:CANSLER HEALTH, LLC
Entity Type:Organization
Organization Name:CANSLER HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:931-494-0456
Mailing Address - Street 1:308 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2038
Mailing Address - Country:US
Mailing Address - Phone:931-494-0456
Mailing Address - Fax:270-770-2221
Practice Address - Street 1:308 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2038
Practice Address - Country:US
Practice Address - Phone:931-494-0456
Practice Address - Fax:270-770-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100644560Medicaid