KENT WESLEY CANNON (PSY.D.) – Clinical Psychologist, NPI 1194581660

KENT WESLEY CANNON (PSY.D.) is a healthcare provider. based in Lincoln, Nebraska. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSY.D.. They hold a License No. 1046 (NE). The NPI Number for KENT WESLEY CANNON (PSY.D.) is 1194581660

Main info

Male
32 Years Of Experience
Accepts Medicare Assignment
Name
KENT WESLEY CANNON (PSY.D.)
NPI
1194581660
Phone
(402) 481-5636
Address
2300 S 16TH ST
Enumeration Date
22 February 2024
Last Update Date
23 July 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4024815991
Graduation Year
1994 (32 years ago)
PAC ID
0244773679
Group Practice PAC ID
4284628652
Professional Enrollment ID
I20240613003256
Address ID
NE685023700LI2221XSTXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness85
Years active:2State licenses:1Digital endpointsOther names

200 CLINICAL PSYCHOLOGIST in NE

Provider Addresses for KENT WESLEY CANNON (PSY.D.)

  • 2300 S 16TH ST

    LINCOLN, NE 685023704

    Phone: (402) 481-5636

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-06-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240613003256IClinical PsychologistNETBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 68502)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4284628652View full group profile
NameSpecialtyState
-NE
Clinical PsychologistNE
Clinical PsychologistNE
Diagnostic RadiologyCO
Diagnostic RadiologyUT
Diagnostic RadiologyUT
Diagnostic RadiologyTX
Registered Dietitian Or Nutrition ProfessionalNE
Diagnostic RadiologyMO
Hematology/Oncology, Internal MedicineNE

Reviews

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Frequently asked questions

Does KENT WESLEY CANNON (PSY.D.) share an NPI with anyone else?
NPI numbers are unique to each provider or organization — KENT WESLEY CANNON (PSY.D.) uses 1194581660.
Does CMS list KENT WESLEY CANNON (PSY.D.) as active?
Yes — KENT WESLEY CANNON (PSY.D.) is active in the NPI listing used on this page.
What is KENT WESLEY CANNON (PSY.D.)'s specialty?
The listing groups KENT WESLEY CANNON (PSY.D.) with Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Where should I expect KENT WESLEY CANNON (PSY.D.) on a map?
Expect Lincoln, Nebraska as a primary anchor for KENT WESLEY CANNON (PSY.D.) unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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