Provider Demographics
NPI:1194961284
Name:CANNON, DOROTHY
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5216 YOUNG DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1832
Mailing Address - Country:US
Mailing Address - Phone:469-328-5426
Mailing Address - Fax:
Practice Address - Street 1:5216 YOUNG DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-1832
Practice Address - Country:US
Practice Address - Phone:469-328-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X, 171W00000X, 171WV0202X, 172A00000X, 172V00000X
TX24603614347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171W00000XOther Service ProvidersContractor
No171WV0202XOther Service ProvidersContractorVehicle Modifications
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No347C00000XTransportation ServicesPrivate Vehicle