Individual provider Active NPI

Dylan Canada

  • Certified Registered Nurse Anesthetist
  • Jonesboro, AR
National Provider Identifier
1366335267
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
234098 Issued in AR
Practice address
4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone
(870) 936-1000
NPI assigned
May 30, 2025
Last updated
Nov 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 234098 AR Primary

Addresses

Primary practice location

4800 E Johnson Ave
Jonesboro, AR 72405-8413

Mailing address

14706 Kelsey Vista Dr
Cypress, TX 77433-6825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251013001983 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870080088 Reassigns benefits to 1 organization
I20260601001964 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870080088

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifelinc Anesthesia V, P.a.Group PAC ID 8921359712, 41 clinicians

Practice addresses (Care Compare)

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
234098ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelinc Anesthesia V, P.a. Nurse Anesthetist, Certified Registered CurrentSince Sep 10, 2025 Accepting new patients

Locations

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

3340 Players Club Pkwy
Ste 350
Memphis, TN 38125
Phone (901) 207-2017

Organizations & group practices 1

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 1

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": "1748563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1366335267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14706 KELSEY VISTA DR",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774336825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724058413",
            "telephone_number": "870-936-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANADA",
        "first_name": "DYLAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "234098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.