Lorena Cannon LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LORENA CANNON LLC

Doing business as

Peachtree Medical Care, LLC
Peachtree Medical Clinic

Practice address

893 E 9400 S
Sandy, UT 84094-3671

Phone

(385) 335-7862

NPI assigned

Feb 4, 2021

Organization subpart

No

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

Authorized official

Name

Lorena Cannon, APRNNPI 1255992202

Title

Owner / Provider

Phone

(208) 351-5458

Specialties & licenses 2

Addresses

Other names 2

• Peachtree Medical Care, LLC Doing business as
• Peachtree Medical Clinic Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lorena Cannon, APRN

  • Nurse Practitioner
  • Sandy, UT
  • NPI 1255992202
  Medicare reassignment NPD Authorized official
• Vanesa Nicol Cannon Judd

  • Nurse Practitioner
  • Sandy, UT
  • NPI 1467132621
  NPD

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1235721879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "893 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840943671",
            "telephone_number": "385-335-7862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "893 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840943671",
            "telephone_number": "385-335-7862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORENA CANNON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "OWNER / PROVIDER",
        "authorized_official_telephone_number": "208-351-5458",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "peachtreemedical@direct.practicefusion.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "893 E 9400 S",
            "city": "Sandy",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840943671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Peachtree Medical Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peachtree Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lone Peak Primary Care LLC
• Peter Lonergan
• Jennifer Elizabeth Longenecker, CCC-SLP
• Jennifer Longmore, CMHC
• Melissa D Lonnecker, PA-C
• Makenzi Kaye Lorenzen
• Jeralyn Smith Lovell, B.S.N.
• Danica D. F. Loveridge, CNM, DNP
• Joshua B T R M Lowry, MD
• Aleck Lozano

• Clinic/Center in Sandy, UT
• Providers in Sandy, UT by specialty
• Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.