Bobby Ray Cannon
Individual provider Active NPI Counselor · Morrilton, AR
NPI 1831461565 · NPPES record last updated Jan 26, 2012
Key facts
- NPI
- 1831461565
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 1300 Highway 9
Morrilton, AR 72110-9403 - Phone
- (501) 208-5911
- NPI assigned
- Jan 26, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
1300 Highway 9
Morrilton, AR 72110-9403
Mailing address
602 N Walton Blvd
Bentonville, AR 72712-4576
Phone (479) 271-6302
Other providers in Morrilton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.