Provider Demographics
NPI:1598903213
Name:CANNON, DEBRA SUE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUE
Last Name:CANNON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 HIGHWAY 22 N
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:TN
Mailing Address - Zip Code:38390-4329
Mailing Address - Country:US
Mailing Address - Phone:731-535-3114
Mailing Address - Fax:731-535-3636
Practice Address - Street 1:37 WALLACE LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:TN
Practice Address - Zip Code:38390
Practice Address - Country:US
Practice Address - Phone:731-535-3114
Practice Address - Fax:731-535-3636
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner