Provider Demographics
NPI:1598844359
Name:CANNADAY, RODNEY KENT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:KENT
Last Name:CANNADAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232573367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX232573OtherREGISTERED NURSE LICENSE
TXTXRNOtherWORKER'S COMP
TXP00174856OtherRR MEDICARE
TX84095UOtherBCBS
TX119725OtherCHIP
TXTXRN232573OtherCHAMPUS
TXTXRN232573OtherCHAMPUS