Ericia Latrice Cannon, NURSE PRACTITONER
Individual provider Active NPI Family Nurse Practitioner · Jackson, MS
NPI 1013473891 · NPPES record last updated Mar 7, 2019
Key facts
- NPI
- 1013473891
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 903107 (MS)
- Practice address
- 3502 W Northside Dr
Jackson, MS 39213-4454 - Phone
- (601) 362-5321
- NPI assigned
- Feb 16, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 903107 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Care Clinic, Inc. | Current |
Accepting new patients | |
| Community Care Health Network LLC | Current |
Accepting new patients | |
| Horizon Medical Providers LLC | Current |
Accepting new patients | |
| Family Health Care Clinic, Inc. | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
1551 W Government St
Brandon, MS 39042
Phone (601) 825-3163
290 Highway 51 N
Brookhaven, MS 39601
Phone (601) 823-1710
232 Market St
Jackson, MS 39232
Phone (588) 498-6767
4635 Highway 80 E
Pearl, MS 39208
Phone (601) 933-2500
141 Township Ave
Ste 107
Ridgeland, MS 39157
Phone (601) 201-3121
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 903107 | MS | Yes |
Addresses
Primary practice location
3502 W Northside Dr
Jackson, MS 39213-4454
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321
Other providers in Jackson, MS
- Victoria Canada
- Candid Mississippi, P.C.
- Ashley Miller Canizaro
- Colleen G Cannon
- D Timothy Cannon
- Lauren Elizabeth Cantrell
- Meagan Cantrelle
- Christopher Thai Cao
- Capital City Children and Adolescent Clinic
- Capital City Endocrine Clinic LLC
All providers in Jackson, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.