Active NPI
Kimberly Joy Canon
- Pharmacist
- Jacksonville, TX
National Provider Identifier
1639784168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 27385
- Practice address
- 210 E Cherokee St
Jacksonville, TX 75766-4899 - Phone
- (903) 586-2284
- Fax
- (903) 586-2285
- NPI assigned
- Sep 11, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 27385 | TX | Primary |
Addresses
Primary practice location
210 E Cherokee St
Jacksonville, TX 75766-4899
Mailing address
210 E Cherokee St
Jacksonville, TX 75766-4899
Phone (903) 586-2284
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27385 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599782400000",
"number": "1639784168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 E CHEROKEE ST",
"city": "JACKSONVILLE",
"state": "TX",
"postal_code": "757664899",
"telephone_number": "903-586-2284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 E CHEROKEE ST",
"city": "JACKSONVILLE",
"state": "TX",
"postal_code": "757664899",
"telephone_number": "903-586-2284",
"fax_number": "903-586-2285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANON",
"first_name": "KIMBERLY",
"middle_name": "JOY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-11",
"last_updated": "2020-09-11",
"certification_date": "2020-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "27385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.