Doctor Name: | KYLE CANNADY |
NPI Number: | 1457733826 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | RN221018 |
Business Practice Address: | 400 Cedar St Metter, GA - 304393338 |
Business Phone Number: | 9126855741 |
Business Fax Number: | |
Mailing Address: | 400 Cedar St, METTER |
State: | GA |
Postal Code: | 304393338 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/22/2015 |
NPI Last Update Date: | 06/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN221018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |