Provider Demographics
NPI:1184953614
Name:MEACHAM-CANNON, DENISE (CNIM, CRET, REPT)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:MEACHAM-CANNON
Suffix:
Gender:F
Credentials:CNIM, CRET, REPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 TOWN SQUARE PL STE 290
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1643
Mailing Address - Country:US
Mailing Address - Phone:281-768-6730
Mailing Address - Fax:281-768-6766
Practice Address - Street 1:2150 TOWN SQUARE PL STE 290
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1643
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:281-768-6766
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCNIM994246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic