DR. SCOT KENNETH CANFIELD (PHD,APN-BC) – Nurse Practitioner, NPI 1104989862

DR. SCOT KENNETH CANFIELD (PHD,APN-BC) is a healthcare provider. based in Cordova, Tennessee. specializing in NURSE PRACTITIONER. They hold the professional credentials PHD,APN-BC. They hold a License No. 25684 (TN). The NPI Number for DR. SCOT KENNETH CANFIELD (PHD,APN-BC) is 1104989862

Main info

Male
32 Years Of Experience
Accepts Medicare Assignment
Name
DR. SCOT KENNETH CANFIELD (PHD,APN-BC)
NPI
1104989862
Phone
(901) 752-8773
Address
8863 DEWBERRY LN
Enumeration Date
17 December 2006
Last Update Date
1 April 2026

Doctor Profile

Medical School Name
UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1994 (32 years ago)
PAC ID
5092704346
Professional Enrollment ID
I20260217001619
Address ID
TN380186317Co993XXAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience80
Completeness85
Years active:19State licenses:3Digital endpointsOther names

10,664 NURSE PRACTITIONER in TN

Provider Addresses for DR. SCOT KENNETH CANFIELD (PHD,APN-BC)

  • 8863, Dewberry Lane, Cordova, Memphis, Shelby County, West Tennessee, Tennessee, 38016, United States

    CORDOVA, TN 380164010

    Phone: (901) 752-8773

    Type: Mailing

  • 993 CORDOVA STATION AVE

    CORDOVA, TN 380186317

    Phone: (901) 737-4565

    Type: Mailing

  • 703, Calvin Avery Drive, West Memphis, Crittenden County, Arkansas, 72301, United States

    WEST MEMPHIS, AR 723016501

    Phone: (870) 732-1878

    Type: Location

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: 2026-02-17

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
I20260217001619INurse PractitionerTNTBD

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 38016)

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Reviews

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Frequently asked questions

Where can patients find DR. SCOT KENNETH CANFIELD (PHD,APN-BC)'s NPI?
You can confirm DR. SCOT KENNETH CANFIELD (PHD,APN-BC) with NPI 1104989862; it appears in the national provider directory.
Is DR. SCOT KENNETH CANFIELD (PHD,APN-BC)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What field does DR. SCOT KENNETH CANFIELD (PHD,APN-BC) work in?
You can think of DR. SCOT KENNETH CANFIELD (PHD,APN-BC) as practicing within Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location metadata exists for DR. SCOT KENNETH CANFIELD (PHD,APN-BC)?
The page summarizes Cordova, Tennessee for DR. SCOT KENNETH CANFIELD (PHD,APN-BC); expand the address list for detail.
Is DR. SCOT KENNETH CANFIELD (PHD,APN-BC) a real provider?
This page reflects official NPPES data for NPI 1104989862. Always confirm identity and privileges with the practice and licensing boards.

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