MEDICARE: KEUNNA CANNON CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1154142438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEUNNA CANNON CNM

Provider Business Mailing Address
First Line	:	1573 KLEBERG DR
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-1369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 W PARMER LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-4107
Country	:	US
Telephone Number	:	512-368-9370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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Directions to “ KEUNNA CANNON CNM” Practice Location

Language	Start Address	Practice Location

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