Provider Demographics
NPI:1417208984
Name:CANNON, MEGAN T (NP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:T
Last Name:CANNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE G-11
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-287-7804
Mailing Address - Fax:804-287-7178
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE G-11
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-287-7804
Practice Address - Fax:804-287-7178
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA24169121363LF0000X
VA0024169121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN