Provider Demographics
NPI:1609612100
Name:CANNON HEALTH
Entity type:Organization
Organization Name:CANNON HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC, FNP-C, CKNS
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-C,CKNS
Authorized Official - Phone:520-800-9282
Mailing Address - Street 1:1620 S PLACITA CHURELLA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-7714
Mailing Address - Country:US
Mailing Address - Phone:520-800-9282
Mailing Address - Fax:866-403-5117
Practice Address - Street 1:6700 E SPEEDWAY BLVD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-800-9282
Practice Address - Fax:866-403-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty