DUSTIN CANNON (NPI# 1891200036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891200036 |
| Entity Type | Individual |
| Full Name | DUSTIN CANNON |
| Practice Address |
737b North Drive Hopkinsville KY 42240 |
| Mailing Address |
3999 Fort Campbell Blvd Hopkinsville KY 42240-4929 |
| Practice Telephone | 2708901780 |
| Practice Fax Number | 2708901789 |
| Mailing Telephone | 2708862205 |
| Mailing Fax Number | 2708860392 |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2017-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
737B NORTH DRIVE |
| City | HOPKINSVILLE |
| State | KY |
| Zip Code | 42240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508949793 | Ashley Felts Boze | Social Worker | 737b North Drive, Hopkinsville, KY 42240-2620 | 2006-10-23 |
| 1437641859 | Carolyn D. Carter | Counselor | 737b North Drive, Hopkinsville, KY 42240 | 2018-06-01 |
| 1013113745 | Steven Lee Thore | Psychiatry & Neurology | 737b North Drive, Hopkinsville, KY 42240 | 2007-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689214264 | Joshua Brian Yates | Pharmacist | 320 West 18th Street, Hopkinsville, KY 42240 | 2020-01-10 |
| 1629540950 | John J Tomasic | Nurse Practitioner | Jennie Stuart Medical Center, 320 W 18th Street, Hopkinsville, KY 42240 | 2018-12-27 |
| 1669962866 | Jeri Lynn Richardson | Developmental Therapist | 119 Forbes Dr, Hopkinsville, KY 42240 | 2018-05-14 |
| 1619416039 | Esther Caro | Case Manager/Care Coordinator | 400a Hammond Plz, Hopkinsville, KY 42240 | 2017-02-17 |
| 1780126532 | Jennifer R. Koranyi | Social Worker | 737b North Dr, Hopkinsville, KY 42240 | 2016-11-10 |
| 1043760937 | Inspira Therapy | Speech-Language Pathologist | 1110 South Main Street, Suite B, Hopkinsville, KY 42240 | 2016-10-04 |
| 1689026049 | Judy Greene Dba Greene Physical Therapy Services | Physical Therapist | 1910 South Virginia Ste., Ste. 108, Hopkinsville, KY 42240 | 2016-07-11 |
| 1083094932 | Cornell Memory Center | Clinic/Center | 101 North Drive, Hopkinsville, KY 42240 | 2015-06-05 |
| 1679978746 | Maulik V Patel | Pharmacist | 2713 A Fort Campbell Blvd, Hopkinsville, KY 42240 | 2014-10-30 |
| 1245630896 | Haregewoin Ezezew Baye | Dentist | 300 Cool Water Ct, Hopkinsville, KY 42240 | 2014-09-02 |
| Find all providers in zip 42240 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063048213 | Linda Kuhlenbeck | Peer Specialist | 737a North Dr, Hopkinsville, KY 42240-2620 | 2020-03-19 |
| 1780219865 | Victoria Tarpley | Peer Specialist | 290 Burley Ave, Hopkinsville, KY 42240-8725 | 2020-03-09 |
| 1134754690 | Nathan Ragsdale | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-05 |
| 1881229383 | Timothy Hendricks | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-05 |
| 1669017216 | Rocky Trusty | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8725 | 2019-11-07 |
| 1689215915 | David Fontaine | Peer Specialist | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2019-10-08 |
| 1013558337 | Meredith Ezell | Peer Specialist | 290 Burley Ave, Hopkinsville, KY 42240-8725 | 2019-10-08 |
| 1043851470 | Julianna Dejesus | Peer Specialist | 100 Trilogy Ave, Hopkinsville, KY 42240-5329 | 2019-10-07 |
| 1558912055 | Paula Shaffer | Peer Specialist | 290 Burley Ave, Hopkinsville, KY 42240-8725 | 2019-09-25 |
| 1548811557 | Glenn Edwin Childress | Peer Specialist | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2019-09-23 |
| Find all providers in HOPKINSVILLE | ||||
| City | HOPKINSVILLE |
| Zip Code | 42240 |
Please comment or provide details below to improve the information on DUSTIN CANNON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.