Matthew Cannella, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0506403 Issued in NV

Practice address

980 Kelly Johnson Drive
Suite 200
Las Vegas, NV 89119

Phone

(702) 732-5529

NPI assigned

Feb 22, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Missouri State University

  dba Northwest Missouri State

  • Family Medicine Physician
  • Maryville, MO
  • NPI 1225310204

  Athletic Trainer

  NPD Authorized official
• Northwest Missouri State University

  dba NWMSU Wellness Center

  • Student Health Clinic/Center
  • Maryville, MO
  • NPI 1760542567
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1164961108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 KELLY JOHNSON DR STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891193768",
            "telephone_number": "702-732-5529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 KELLY JOHNSON DRIVE",
            "address_2": "SUITE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89119",
            "telephone_number": "702-732-5529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNELLA",
        "first_name": "MATTHEW",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NV",
            "license": "0506403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosalyn Canlas
• Cann Investments LLC (Cann Medical Supply)
• Jessica Cann
• Miesha Cannady
• Marianelys Cannavacciuolo
• Laura Canney
• Aileen Cannon
• Alyson M. Cannon, LMFT
• Cody Cannon
• Deshyla Janae Cannon

• Athletic Trainer in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Athletic Trainer in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.