Jennifer Cannon, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

1942863154 Issued in VA

Practice address

BLDG 50, Farenholt Avenue
Agana Heights, GU 96910

Phone

(671) 344-9340

NPI assigned

Apr 15, 2019

Last updated

Jun 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• NH Guam

  • Military/U.S. Coast Guard Pharmacy
  • Agana Heights, GU
  • NPI 1558214809
  NPD (past)

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1942863154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "PSC 455 BOX 208",
            "city": "FPO",
            "state": "AP",
            "postal_code": "965400003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 50, FARENHOLT AVENUE",
            "city": "AGANA HEIGHTS",
            "state": "GU",
            "postal_code": "96910",
            "telephone_number": "671-344-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-15",
        "last_updated": "2024-06-05",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "1942863154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Randall Brown, DMD
• James Brunswick, MD
• Danielle Buccine
• Charles Clifton Burroughs, NP
• Sheehan Murphy Byrne, LISW
• Ann Carnevale, MD
• Nicole Christianne Carson, FNP-BC, APRN
• Rodger Besley Carter III, DO
• Eunice Joy P Castro, PH.D.
• Rachel D Ceria, RN

• Surgery Physician in Agana Heights, GU
• Providers in Agana Heights, GU by specialty
• Surgery Physician in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.