Healthcare Provider Details

I. General information

NPI: 1154810190
Provider Name (Legal Business Name): EMMA CHRISTINE CANION FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTY GRAHAM CANION

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W GOODWIN AVE STE 600
VICTORIA TX
77901-6757
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 361-827-4637
  • Fax:
Mailing address:
  • Phone: 800-828-0898
  • Fax: 330-493-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number736017
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP138580
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: