Healthcare Provider Details

I. General information

NPI: 1609612100
Provider Name (Legal Business Name): CANNON HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 E SPEEDWAY BLVD.
TUCSON AZ
85710
US

IV. Provider business mailing address

1620 S PLACITA CHURELLA
TUCSON AZ
85748-7714
US

V. Phone/Fax

Practice location:
  • Phone: 520-800-9282
  • Fax: 866-403-5117
Mailing address:
  • Phone: 520-800-9282
  • Fax: 866-403-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARRIE EILEEN CANNON
Title or Position: PMHNP-BC, FNP-C, CKNS
Credential: PMHNP-BC, FNP-C,CKNS
Phone: 520-800-9282