Carolyn L Cannon, MD PHD

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

License

N4322 Issued in TX

Practice address

5323 Harry Hines Blvd
Dallas, TX 75390-7201

Phone

(214) 456-2857

Fax

(214) 456-5406

NPI assigned

Jul 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Carolyn Louise Preston Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ccannon185325@prddirect.texaschildrens.org

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

• University of Texas Southwestern Medical Center at Dallas

  • Anesthesiology Physician
  • Dallas, TX
  • NPI 1942270566

  Pediatric Pulmonology

  Medicare reassignment NPD
• The University of Texas Southwestern Medical Center at Dallas

  • Clinical Medical Laboratory
  • Dallas, TX
  • NPI 1396832713
  NPD
• University of Texas Southwestern Medical Center at Dallas

  • Pediatrics Physician
  • Southlake, TX
  • NPI 1275838732
  NPD

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1740208552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 E 29TH ST",
            "address_2": "STE 100",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022623",
            "telephone_number": "979-436-0501",
            "fax_number": "979-776-6905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753907201",
            "telephone_number": "214-456-2857",
            "fax_number": "214-456-5406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "CAROLYN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "MO",
            "license": "2003014838",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "TX",
            "license": "N4322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209230002",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "PRESTON",
            "middle_name": "LOUISE",
            "credential": "MD PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Jarred Cannaday, MD
• Peter Cannamela
• Cannenta Center for Healing and Empowerment LLC
• Juliet Cannizzo
• Betty Kay Cannon, LPC
• Lynnise Cannon, CRNA
• Olivia Cannon, LMSW
• Scott Cannon, DMD
• Stephen Caldwell Cannon, MD PHD
• Tamara Cannon, PHD

• Pediatric Pulmonology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Pediatric Pulmonology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.