Provider Demographics
NPI:1255127239
Name:CANNON, LAUREL LEIGH
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:LEIGH
Last Name:CANNON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5040
Mailing Address - Country:US
Mailing Address - Phone:870-464-1337
Mailing Address - Fax:
Practice Address - Street 1:702 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5040
Practice Address - Country:US
Practice Address - Phone:870-464-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist