Healthcare Provider Details

I. General information

NPI: 1629989470
Provider Name (Legal Business Name): JASMINE ELAINE CANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8255 MACON RD UNIT 185
CORDOVA TN
38088-0045
US

IV. Provider business mailing address

8255 MACON RD UNIT 185
CORDOVA TN
38088-0045
US

V. Phone/Fax

Practice location:
  • Phone: 662-820-0860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8941
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: