Provider Demographics
NPI:1760713945
Name:KANADY, JARROD DWAYNE (FNP)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:DWAYNE
Last Name:KANADY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-8468
Mailing Address - Country:US
Mailing Address - Phone:336-225-1470
Mailing Address - Fax:
Practice Address - Street 1:2403 WOOD DUCK DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-8468
Practice Address - Country:US
Practice Address - Phone:336-225-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily