Individual provider Active NPI

Donna Cannon, FNP-C

  • Family Nurse Practitioner
  • Blue Mountain, MS
National Provider Identifier
1306236617
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R874646 Issued in MS
Practice address
1755 County Road 81
Blue Mountain, MS 38610-9657
Phone
(662) 538-4111
NPI assigned
Jan 26, 2015
Last updated
Jan 26, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R874646 MS Primary

Addresses

Primary practice location

1755 County Road 81
Blue Mountain, MS 38610-9657

Mailing address

1755 County Road 81
Blue Mountain, MS 38610-9657
Phone (662) 538-4111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160119000510 MS Practitioner - Nurse Practitioner 6204139678 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mantachie Rural Health Care, IncGroup PAC ID 2567372121, 12 clinicians

Practice addresses (Care Compare)

5681 Hwy 363
Mantachie, MS 38855-7632
Phone (662) 282-4226

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mantachie Rural Health Care, Inc CurrentSince Jan 3, 2017 Accepting new patients
Mantachie Rural Health Care, Inc CurrentSince Jan 3, 2017 Accepting new patients
Mantachie Rural Health Care, Inc. Dental Past Accepting new patients
Cotton Plant Clinic Past Accepting new patients

Locations

5500 Highway 363
Mantachie, MS 38855
Phone (662) 282-4226

5681 Highway 363
Mantachie, MS 38855
Phone (662) 255-1567

Interoperability endpoints

  • Direct secure messaging: donna.cannon@mrhc.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/IIBHBA

Organizations & group practices 4

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422230400000",
    "number": "1306236617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 COUNTY ROAD 81",
            "city": "BLUE MOUNTAIN",
            "state": "MS",
            "postal_code": "386109657",
            "telephone_number": "662-538-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 COUNTY ROAD 81",
            "city": "BLUE MOUNTAIN",
            "state": "MS",
            "postal_code": "386109657",
            "telephone_number": "662-538-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "DONNA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R874646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Mountain, MS

Sources for this page

Verify at the official NPI Registry.