MEDICARE: KANAYOCHUKWU KANNY JACQUELYNE ANYA M.D.

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	208600000X	Surgery Physician	54922-20	WI
2	208600000X	Surgery Physician	MD204301	LA
3	208600000X	Surgery Physician	N9800	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821278151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANAYOCHUKWU KANNY JACQUELYNE ANYA M.D.

Provider Business Mailing Address
First Line	:	6100 HARRIS PARKWAY
Second Line	:	SUITE 380
City	:	FORT WORTH
State	:	TX
Zip	:	76132
Country	:	US
Telephone Number	:	817-759-9008
Fax Number	:	844-583-5414

Provider Business Practice Location Address
First Line	:	6048 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3706
Country	:	US
Telephone Number	:	817-270-4243
Fax Number	:	817-270-4249

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

Provider Enumeration Date	:	11/03/2007
Last Update Date	:	08/04/2017

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