Provider Demographics
NPI:1568541308
Name:R. KENT CANNADAY, CRNA, PLLC
Entity Type:Organization
Organization Name:R. KENT CANNADAY, CRNA, PLLC
Other - Org Name:N / A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:CANNADAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:936-564-7400
Mailing Address - Street 1:4011 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-6528
Mailing Address - Country:US
Mailing Address - Phone:936-564-7400
Mailing Address - Fax:936-560-0559
Practice Address - Street 1:3610 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2539
Practice Address - Country:US
Practice Address - Phone:936-560-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232573367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C38SOtherBCBS GROUP #
TXDC5332OtherRAIL ROAD MEDICARE
TX=========OtherFEDERAL EIN
TX=========OtherWORKER'S COMPENSATION
TX00C38SOtherBCBS GROUP #