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General NPI Number Information
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NPI Number | 1821278151
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Entity Type | Individual
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Provider Name | KANAYOCHUKWU KANNY JACQUELYNE ANYA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/03/2007
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Last Update Date | 08/04/2017
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Provider Practice Location Address
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Address Line | 6048 LAKE WORTH BLVD
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City | FORT WORTH
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State | TX
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Zip | 76135-3706
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Country | US
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Telephone | 817-270-4243
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Fax | 817-270-4249
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Provider Business Mailing Address
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Address Line | 6100 HARRIS PARKWAY SUITE 380
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City | FORT WORTH
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State | TX
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Zip | 76132
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Country | US
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Telephone | 817-759-9008
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Fax | 844-583-5414
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 54922-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD204301
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | N9800
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License Number State | TX
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