Individual provider Active NPI

Emily J Cannon, ACNP

  • Acute Care Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1720319130
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
723802 Issued in TX
Practice address
619 S Fleishel Ave
Tyler, TX 75701-2004
Phone
(903) 606-1264
NPI assigned
Jan 25, 2010
Last updated
Oct 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP118873 TX
Acute Care Nurse Practitioner 363LA2100X 723802 TX Primary

Addresses

Primary practice location

619 S Fleishel Ave
Tyler, TX 75701-2004

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6400

Other practice location 1

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

Other practice location 2

619 S Fleishel Ave Ste 101
Tyler, TX 75701-2004
Phone (903) 606-2296

Other practice location 3

619 S Fleishel Ave Ste 201
Tyler, TX 75701-2004
Phone (903) 606-7061

Other identifiers 4

IdentifierTypeStateIssuer
1C3376OtherTXMEDICARE
398191220MedicaidTX
8MK526OtherTXBCBS
P02469301OtherTXMEDICARE RAIL ROAD

Other names 1

  • Emily J Evans Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100316000755 TX Practitioner - Nurse Practitioner 0345375358 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

105 Zeid Blvd
Henderson, TX 75652-6070
Phone (903) 595-2283

1302 N Pacific St
Christus Trinity Clinic
Mineola, TX 75773-1022
Phone (903) 569-5383

18780 Interstate 20
Canton, TX 75103-3593
Phone (903) 567-4841

3201 S Loop
Palestine, TX 75801-6901

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP118873TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jun 8, 2020 Accepting new patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jun 8, 2020 Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

619 S Fleishel Ave
Tyler, TX 75701
Phone (903) 606-2830

619 S Fleishel Ave
Ste 101
Tyler, TX 75701
Phone (903) 606-2296

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

912 S Fleishel Ave
Tyler, TX 75701
Phone 90359269011811

Interoperability endpoints

  • Direct secure messaging: eevans@psotmd.gwaydirect.com
  • Direct secure messaging: eevans110485@christushealth.direct-ci.net

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 2

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": "1264377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791244800000",
    "number": "1720319130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400",
            "fax_number": "903-592-9986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012004",
            "telephone_number": "903-606-1264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "912 S Fleishel Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012018",
            "country_code": "US",
            "telephone_number": "903-592-6901",
            "fax_number": "903-592-9986",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 S Fleishel Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012004",
            "country_code": "US",
            "telephone_number": "903-606-2296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 S Fleishel Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012004",
            "country_code": "US",
            "telephone_number": "903-606-7061",
            "fax_number": "903-606-5933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "EMILY",
        "middle_name": "J",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-25",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP118873",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "723802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1C3376",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "398191220",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8MK526",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02469301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "EVANS",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.