Healthcare Provider Details

I. General information

NPI: 1760713945
Provider Name (Legal Business Name): JARROD DWAYNE KANADY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 HUFFMAN MILL RD STE 105
BURLINGTON NC
27215-5113
US

IV. Provider business mailing address

154 HUFFMAN MILL RD STE 105
BURLINGTON NC
27215-5113
US

V. Phone/Fax

Practice location:
  • Phone: 743-336-7811
  • Fax: 833-764-4123
Mailing address:
  • Phone: 743-336-7811
  • Fax: 833-764-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177401
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number194534
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5004634
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: