Su-San Cannon Spain

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Practice address

1712 Wurzburg Dr
Fort Worth, TX 76134-3320

Phone

(817) 476-1510

NPI assigned

Aug 17, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1790397255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16741",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761620741",
            "telephone_number": "817-476-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 WURZBURG DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761343320",
            "telephone_number": "817-476-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON SPAIN",
        "first_name": "SU-SAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-17",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheryl Canida, LCDC
• Betty Ailed Canizares
• Haley Banks Cannaday, PA-C
• Tracy Lynn Cannell
• James Cannici, PHD
• Holly Cannon, DO
• Jennifer Leigh Cannon, RN
• Milton Van Cannon, DDS
• Rachel Cannon
• Adrienne Cano, RN

• In Home Supportive Care Agency in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• In Home Supportive Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.

Verify at the official NPI Registry.