Amanda Graves Cannon, FNP
Individual provider Active NPI Family Nurse Practitioner · Vineyard, UT
NPI 1760968804 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1760968804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 9111041-4405 (UT)
- Practice address
- 667 E 500 N Ste 200
Vineyard, UT 84059-6004 - Phone
- (801) 669-5758
- Fax
- (801) 216-8357
- NPI assigned
- Jul 12, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241119002876 | UT | Practitioner - Nurse Practitioner | 1153650569 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9111041-4405 | UT | MD | Family Nurse Practitioner |
| 911041 | UT | MD | Obstetrics & Gynecology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Obstetrics and Gynecology, P.C. | Current |
Accepting new patients | |
| Valley Obstetrics and Gynecology, PC | Current |
Accepting new patients | |
| Valley Obstetrics and Gynecology, PC | Current | Accepting new patients | |
| Draper Family Medical Associates, LLC | Family Medicine | Past |
Accepting new patients |
| Valley Obstetrics and Gynecology, PC | Past |
Accepting new patients |
Locations
700 W 800 N
Ste 200
Orem, UT 84057
Phone (801) 229-2229
1900 N State St
Ste 103
Provo, UT 84604
Phone (801) 669-5758
585 N 500 W
Ste 500
Provo, UT 84601
1900 N State St
Provo, UT 84604
Phone (801) 373-2001
585 N 500 W
Provo, UT 84601
Phone (801) 374-1801
667 E 500 N
Ste 200
Vineyard, UT 84059
Phone (801) 669-5758
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | 911041 | UT | |
| Family Nurse Practitioner | 363LF0000X | 9111041-4405 | UT | Yes |
Addresses
Primary practice location
667 E 500 N Ste 200
Vineyard, UT 84059-6004
Mailing address
667 E 500 N Ste 200
Vineyard, UT 84059-6004
Phone (801) 669-5758
Other practice location 1
700 W 800 N Ste 200
Orem, UT 84057-6316
Phone (016) 695-7588
Other providers in Vineyard, UT
- Badger Management LLC
- Chayla Helen Bigler
- Blackbloom LLC
- Bonsai Therapy LLC
- Matias A Calquin
- Lia Ana Chebeleu
- Jordan Collins
- Devyn Arlie Darrohn
- Heeju Davis
- Rebecca Davis
All providers in Vineyard, UT · Family Nurse Practitioner in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.