Provider Demographics
NPI:1154422749
Name:HAMMONS, CANELLA KELLY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:CANELLA
Middle Name:KELLY
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:CANELLA
Other - Middle Name:KELLY
Other - Last Name:HAMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:6750 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2875
Mailing Address - Country:US
Mailing Address - Phone:972-556-1616
Mailing Address - Fax:972-556-1740
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-556-1616
Practice Address - Fax:972-556-1740
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694255363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP47904Medicare UPIN
TXTXB140668Medicare PIN
TX272733YL7BMedicare PIN