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General NPI Number Information
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NPI Number | 1336780147
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Entity Type | Individual
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Provider Name | KRISTEN LEEANN CANADY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 610 OCEAN HWY W
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City | SUPPLY
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State | NC
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Zip | 28462-4048
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Country | US
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Telephone | 910-356-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 5864 N RHETT AVE APT 5B
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City | HANAHAN
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State | SC
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Zip | 29410-2531
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Country | US
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Telephone | 252-558-3232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-09492
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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