Provider Demographics
NPI:1629008768
Name:CANION, NICHOLAS JOHN (NP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:CANION
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:CANION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:402 N BRYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5257
Mailing Address - Country:US
Mailing Address - Phone:325-655-5125
Mailing Address - Fax:325-655-5340
Practice Address - Street 1:402 N BRYANT BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5257
Practice Address - Country:US
Practice Address - Phone:325-655-5125
Practice Address - Fax:325-655-5340
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ279913363LF0000X
TXAP114373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ58737Medicare UPIN
TX8L9615Medicare PIN